Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0103X | Foot & Ankle Surgery | 251 | KY |
NPI | 1063402972 |
---|---|
Provider Name | Dr. Keith Wellington Myrick |
First Address | Louisville, KY 40205-3340 |
Second Address | Louisville, KY 40205-3340 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/10/2005 |
Last Update Date | 30/08/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0000000382017 | BLUE PREFERRED (ANTHEM) (01) | KY |
201363620 | (05) | IN |
50007597 | PASSPORT (01) | KY |
80000318 | (05) | KY |
U85669 | (02) |