Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0131X | Foot Surgery | 00254 | KY |
NPI | 1396741096 |
---|---|
Provider Name | Brian J Beach |
First Address | Dry Ridge, KY 41035-9406 |
Second Address | Dry Ridge, KY 41035-9406 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/06/2005 |
Last Update Date | 30/07/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
80002546 | (05) | KY |
U74831 | (02) | KY |