Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QS0010X | Family Doctor - Sports Medicine | 01071492A | IN |
N | 207QS0010X | Family Doctor - Sports Medicine | 2008013228 | MO |
N | 207QS0010X | Family Doctor - Sports Medicine | MD432725 | PA |
NPI | 1023173077 |
---|---|
Provider Name | Dr. Brian Keith Albertson |
First Address | Greenwood, IN 46143-7241 |
Second Address | Corydon, IN 47112-2172 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/12/2006 |
Last Update Date | 15/04/2021 |