Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | TP624 | KY |
Y | 207QS0010X | Family Doctor - Sports Medicine | 04347 | KY |
NPI | 1023496205 |
---|---|
Provider Name | Dr. Scotty Ray Newcomer |
First Address | Chicago, IL 60677-6351 |
Second Address | Louisville, KY 40202-3902 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/05/2015 |
Last Update Date | 13/04/2021 |