Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 9215 | KY |
NPI | 1073868998 |
---|---|
Provider Name | Dr. John Anthony Colgan Jr. |
First Address | Paducah, KY 42003-8043 |
Second Address | Paducah, KY 42003-8043 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/07/2012 |
Last Update Date | 03/02/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
7100218260 | (05) | KY |