Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | 25509 | KY |
N | 207R00000X | Internist | 25509 | KY |
N | 111NI0900X | Internist | 25509 | KY |
NPI | 1033168513 |
---|---|
Provider Name | Dr. Robert Burroughs Coutant |
First Address | Fort Campbell, KY 42223 |
Second Address | Fort Campbell, KY 42223 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/05/2006 |
Last Update Date | 26/11/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C69136 | (02) | KY |