Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RC0000X | Internist - Cardiovascular Disease | 30384 | KY |
Y | 207RC0001X | Clinical Cardiac Electrophysiologist | 30384 | KY |
NPI | 1285634683 |
---|---|
Provider Name | Allen Gregory Deam |
First Address | Louisville, KY 40223-5176 |
Second Address | Louisville, KY 40207-4637 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/07/2005 |
Last Update Date | 03/12/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
64303845 | (05) | KY |
E72211 | (02) | KY |