Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VF0040X | Female Pelvic Medicine and Reconstructive Surgeon | 39021 | KY |
NPI | 1811913585 |
---|---|
Provider Name | Dr. Susan S.b. Tate |
First Address | Louisville, KY 40220-3903 |
Second Address | Louisville, KY 40220-3903 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/07/2006 |
Last Update Date | 29/09/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000337344 | ANTHEM (01) | KS |
000000338030 | ANTHEM (01) | KY |
200502730 | (05) | IN |
50004854 | PASSPORT SPECIALITY (01) | KY |
50004926 | PASSPORT PCP (01) | KY |
50015262 | PASSPORT SPECIALITY (01) | KY |
64084148 | (05) | KY |
E14734 | (02) | KY |