Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 6251 | KY |
NPI | 1093749426 |
---|---|
Provider Name | Dr. Richard P. Broering JR. |
First Address | Edgewood, KY 41017-2352 |
Second Address | Edgewood, KY 41017-2352 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/07/2006 |
Last Update Date | 08/07/2007 |