Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 36460 | KY |
Y | 208600000X | Surgeon | 36460 | KY |
NPI | 1013919489 |
---|---|
Provider Name | Dr. David Werner Koelsch |
First Address | Murray, KY 42071-2400 |
Second Address | Murray, KY 42071 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/08/2005 |
Last Update Date | 13/06/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000191916 | BC/BS PIN # (01) | KY |
H32887 | (02) | KY |