Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | 7669 | KY |
NPI | 1093808735 |
---|---|
Provider Name | Dr. Mark C Nation |
First Address | Louisville, KY 40292 |
Second Address | Louisville, KY 40292 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/10/2006 |
Last Update Date | 08/07/2007 |