Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0400X | Neurologist | 21691 | KY |
NPI | 1043297237 |
---|---|
Provider Name | Dr. Gregory L Pittman |
First Address | Louisville, KY 40295-0248 |
Second Address | Louisville, KY 40207-4683 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/12/2005 |
Last Update Date | 13/12/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000619310 | ANTHEM (01) | KY |
100373790 | (05) | IN |
64216914 | (05) | KY |
P00719573 | RAILROAD MEDICARE (01) | KY |