Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2082S0105X | Plastic Hand Surgeon | 51182 | KY |
NPI | 1639656192 |
---|---|
Provider Name | Dr. Brent Charles Lister Trull |
First Address | Louisville, KY 40217-2281 |
Second Address | Louisville, KY 40202-1858 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/07/2018 |
Last Update Date | 26/07/2018 |