Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | 23350 | KY |
NPI | 1063419794 |
---|---|
Provider Name | Dr. John M Patterson |
First Address | Frankfort, KY 40601-4137 |
Second Address | Frankfort, KY 40601-4137 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2005 |
Last Update Date | 28/03/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
64233505 | (05) | KY |
C75665 | (02) | KY |