Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 26429 | KY |
Y | 207QA0401X | Family Doctor - Addiction Medicine | 26429 | KY |
NPI | 1194708776 |
---|---|
Provider Name | David J. Zoeller |
First Address | Elizabethtown, KY 42701-5924 |
Second Address | Elizabethtown, KY 42701-5924 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/11/2005 |
Last Update Date | 09/02/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000050365 | ANTHEM BCBS (01) | KY |
1510590 | (05) | TN |
4047817 | (05) | TN |
6426429400 | (05) | KY |
B92520 | (02) |