Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | 3677 | KY |
NPI | 1194802215 |
---|---|
Provider Name | Dr. Brent Furnish |
First Address | Louisville, KY 40207-4610 |
Second Address | Louisville, KY 40207-4610 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/11/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T54434 | (02) | KY |