Provider Demographics
NPI:1063416741
Name:MUFFLY, DAVID EDWARD (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:EDWARD
Last Name:MUFFLY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 BLACK DIAMOND RD
Mailing Address - Street 2:
Mailing Address - City:CORBIN
Mailing Address - State:KY
Mailing Address - Zip Code:40701-9526
Mailing Address - Country:US
Mailing Address - Phone:606-528-0600
Mailing Address - Fax:606-528-7413
Practice Address - Street 1:1490 CUMBERLAND FALLS HWY
Practice Address - Street 2:
Practice Address - City:CORBIN
Practice Address - State:KY
Practice Address - Zip Code:40701-2721
Practice Address - Country:US
Practice Address - Phone:606-528-0600
Practice Address - Fax:606-528-7413
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-09
Last Update Date:2011-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY22134174400000X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000048741OtherANTHEM BC/BS
KY64221344Medicaid
KY1427801Medicare ID - Type Unspecified
KY64221344Medicaid