Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 1047589A | IN |
N | 207QG0300X | Family Doctor - Geriatric Medicine | 1047589A | IN |
NPI | 1063595452 |
---|---|
Provider Name | Dr. Jose Salvilla Bada |
First Address | Louisville, KY 40241-3035 |
Second Address | Clarksville, IN 47129-1852 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/10/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H02547 | (02) | IN |