Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 4698 | KY |
N | 1223G0001X | General Practice | 4698 | KY |
N | 213EG0000X | General Practice | 4698 | KY |
NPI | 1003974825 |
---|---|
Provider Name | David Russell Brummett SR. |
First Address | Somerset, KY 42501 |
Second Address | Somerset, KY 42501 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/12/2006 |
Last Update Date | 23/01/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
45004264 | (05) | KY |
60046984 | (05) | KY |