Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | 21485 | KY |
N | 207RA0401X | Internist - Addiction Medicine | 21485 | KY |
NPI | 1104865674 |
---|---|
Provider Name | David A. Wrede |
First Address | Lexington, KY 40509-1961 |
Second Address | Lexington, KY 40502-2235 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/06/2006 |
Last Update Date | 18/09/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000053336 | BLUE CROSS BLUE SHIELD (01) | KY |
000000532758 | BCBS PROVIDER NUMBER (01) | KY |
64214851 | (05) | KY |
C68069 | (02) |