Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 28836 | KY |
N | 207QS0010X | Family Doctor - Sports Medicine | 28836 | KY |
NPI | 1174566152 |
---|---|
Provider Name | Christopher V. Pitcock |
First Address | Louisville, KY 40223-5176 |
Second Address | Louisville, KY 40223-4154 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/06/2006 |
Last Update Date | 02/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000052204 | ANTHEM BCBS (01) | KY |
F74322 | (02) | KY |