Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 6989 | KY |
N | 204E00000X | Oral & Maxillofacial Surgeon | 34851 | KY |
NPI | 1437258365 |
---|---|
Provider Name | Dr. Michael D. Couchot |
First Address | Ashland, KY 41101-1917 |
Second Address | Ashland, KY 41101-1917 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/09/2006 |
Last Update Date | 22/05/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
60001054 | (05) | KY |
61900452 | (05) | KY |
64033103 | (05) | KY |
65935769 | (05) | KY |