Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0129X | Vascular Surgeon | 43021 | KY |
NPI | 1003060294 |
---|---|
Provider Name | Dr. Shane Damien O'keeffe |
First Address | Bowling Green, KY 42102-7697 |
Second Address | Bowling Green, KY 42101-1784 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/11/2008 |
Last Update Date | 06/02/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000779824 | BCBS (01) | |
43021 | LICENSE (01) | KY |
7100143600 | (05) | KY |