Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RG0300X | Geriatric Medicine | 2020-02564 | NC |
Y | 207RH0002X | Hospice and Palliative Medicine | 55018 | KY |
NPI | 1194103002 |
---|---|
Provider Name | Dr. Tyler Smith Mcqueen |
First Address | Louisville, KY 40205-3271 |
Second Address | Louisville, KY 40205-3224 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/05/2015 |
Last Update Date | 22/10/2021 |