Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207K00000X | Allergist & Immunologist | 01043380 | IN |
Y | 207K00000X | Allergist & Immunologist | 27337 | KY |
NPI | 1023082484 |
---|---|
Provider Name | David E Pallares |
First Address | Louisville, KY 40223-2992 |
Second Address | Louisville, KY 40223-5440 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/02/2006 |
Last Update Date | 26/05/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
64273378 | (05) | KY |
G13073 | (02) |