Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0200X | Radiology | 08002033A | IN |
Y | 213ER0200X | Radiology | 08002033A | IN |
N | 111NR0400X | Rehabilitation Chiropractor | 08002033A | IN |
NPI | 1659452738 |
---|---|
Provider Name | Douglas J Breger |
First Address | New Albany, IN 47150-2538 |
Second Address | New Albany, IN 47150-2538 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/10/2006 |
Last Update Date | 15/11/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200483400 | (05) | IN |
V00350 | (02) | IN |