Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | 54865 | KY |
NPI | 1033641519 |
---|---|
Provider Name | Brett Austin |
First Address | Owensboro, KY 42303-1320 |
Second Address | Muncie, IN 47303-3428 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/04/2017 |
Last Update Date | 23/07/2021 |