Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 41925 | KY |
Y | 111NI0900X | Internist | 41925 | KY |
N | 207RA0401X | Internist - Addiction Medicine | 41925 | KY |
NPI | 1518143577 |
---|---|
Provider Name | Dr. Brandon Lyle Houk |
First Address | Elizabethtown, KY 42701-5936 |
Second Address | Elizabethtown, KY 42701-5936 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/01/2008 |
Last Update Date | 24/04/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
50021144 | PASSPORT (01) | KY |
7100049980 | (05) | KY |