Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | NA | KY |
N | 111NI0900X | Internist | NA | KY |
N | 208000000X | Pediatrician | NA | KY |
N | 2080P0201X | Pediatric Allergist | 44489 | KY |
Y | 2080P0214X | Pediatric Pulmonologist | 44489 | KY |
NPI | 1972757367 |
---|---|
Provider Name | Dr. Mark Allen Wurth |
First Address | Lexington, KY 40506-9983 |
Second Address | Lexington, KY 40536-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/11/2008 |
Last Update Date | 14/07/2017 |