Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | MD16062 | KY |
N | 207RA0401X | Internist - Addiction Medicine | 16062 | KY |
NPI | 1245394246 |
---|---|
Provider Name | Dr. Robert Russell Dennison JR. |
First Address | Lexington, KY 40515 |
Second Address | Winchester, KY 40391-8845 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/12/2006 |
Last Update Date | 24/06/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A71951 | (02) | KY |
PENDING | (05) | KY |