Organization
OWENSBORO CANCER CENTER PSC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DATTATRAYA S PRAJAPATI MD (PRINCIPAL OFFICER)
(270) 688-1900
Entity
Organization
Contact information
Practice address
1020 BRECKENRIDGE ST, STE 200, OWENSBORO, KY 42303-1784
(270) 688-1900
(270) 688-1905
Mailing address
PO BOX 1784, OWENSBORO, KY 42302-1784
(270) 688-1900
(270) 688-1905
Taxonomy
Speciality
Code
Description
License number
State
207RX0202X
Medical Oncology Physician
Primary
21298
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000027405
ANTHEM
KY
01
—
000000196488
ANTHEM
KY
01
—
36564
KY LICENSE
KY
05
—
65946162
—
KY
Enumeration date
01/17/2007
Last updated
05/05/2009
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