Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207QA0505X | Family Doctor - Adult Medicine | 14035 | KY |
NPI | 1285726505 |
---|---|
Provider Name | Dr. John Dixon Perrrine |
First Address | Lexington, KY 40502-1917 |
Second Address | Lexington, KY 40536-0284 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/09/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C73669 | (02) | KY |