Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 2018007986 | MO |
Y | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | 52379 | KY |
NPI | 1346683059 |
---|---|
Provider Name | Dr. Timothy Michael Lonergan |
First Address | Bowling Green, KY 42101-1708 |
Second Address | Bowling Green, KY 42103-7940 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/04/2013 |
Last Update Date | 20/06/2019 |