Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 5758 | KY |
Y | 1223G0001X | General Practice | 5758 | KY |
Y | 213EG0000X | General Practice | 5758 | KY |
NPI | 1003974536 |
---|---|
Provider Name | Dr. Gary D. Brown |
First Address | Paintsville, KY 41240-1056 |
Second Address | Paintsville, KY 41240-1056 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/12/2006 |
Last Update Date | 08/11/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
45600319 | (05) | KY |
60057585 | (05) | KY |