Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204C00000X | Sports Medicine Doctor | 19618 | KY |
Y | 207X00000X | Orthopaedic Surgeon | 19618 | KY |
NPI | 1043255201 |
---|---|
Provider Name | Dr. Daniel Deaton Primm |
First Address | Lexington, KY 40536-0208 |
Second Address | Lexington, KY 40536-0208 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/06/2006 |
Last Update Date | 14/12/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1399401 | (02) | |
64196181 | (05) | KY |
D82696 | UPIN (01) | KY |