Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 43400 | KY |
Y | 2080P0214X | Pediatric Pulmonologist | 43400 | KY |
NPI | 1467413658 |
---|---|
Provider Name | Adrian R O'hagan |
First Address | Louisville, KY 40201-0909 |
Second Address | Louisville, KY 40202-3906 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/03/2006 |
Last Update Date | 05/01/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200985480 | (05) | IN |
7100117330 | (05) | KY |
G32051 | (02) |