Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 19174 | KY |
Y | 208600000X | Surgeon | 19174 | KY |
NPI | 1003804527 |
---|---|
Provider Name | Dr. Martha Trimble Mccoy |
First Address | Louisville, KY 40204-2508 |
Second Address | Louisville, KY 40202-3841 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/10/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C69164 | (02) | KY |