Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 40428 | KY |
Y | 207QS0010X | Family Doctor - Sports Medicine | 40428 | KY |
NPI | 1154484277 |
---|---|
Provider Name | Dr. Brian Kyle Macy |
First Address | Bowling Green, KY 42101-1759 |
Second Address | Bowling Green, KY 42101-4000 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/12/2006 |
Last Update Date | 09/08/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
7100014290 | (05) | KY |