Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 580 | KY |
Y | 103TC0700X | Clinical Psychologist | 580 | KY |
NPI | 1013071760 |
---|---|
Provider Name | Dr. Robert William Adams |
First Address | Owensboro, KY 42303-2175 |
Second Address | Owensboro, KY 42303-2175 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/12/2006 |
Last Update Date | 21/04/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
P300022969 | MEDICARE ID-TYPE UNSPECIFIED (01) | KY |