Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QS0010X | Family Doctor - Sports Medicine | 49328 | KY |
N | 207QS0010X | Family Doctor - Sports Medicine | MD.34424 | AL |
NPI | 1134488539 |
---|---|
Provider Name | Dr. Isaac David Miller |
First Address | Leitchfield, KY 42754-1479 |
Second Address | Leitchfield, KY 42754-1479 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/05/2012 |
Last Update Date | 12/03/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
7100422810 | (05) | KY |