Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RH0002X | Hospice and Palliative Medicine | 15586 | KY |
NPI | 1033320619 |
---|---|
Provider Name | Dr. Charles Kenny Maffet |
First Address | Elizabethtown, KY 42701-5541 |
Second Address | Elizabethtown, KY 42701-2444 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/05/2007 |
Last Update Date | 08/12/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
4444056018002 | (05) | KY |
6331 | (02) | KY |