Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 04544 | KY |
N | 207Q00000X | Family Doctor | 125.059121 | IL |
Y | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | 04544 | KY |
NPI | 1114211422 |
---|---|
Provider Name | Daniel Dierfeldt |
First Address | Louisville, KY 40201-0909 |
Second Address | Louisville, KY 40202-5703 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/06/2011 |
Last Update Date | 16/11/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
7100607570 | (05) | KY |