Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 20388 | KY |
NPI | 1003901018 |
---|---|
Provider Name | Dr. William Bryan Harrell |
First Address | Bowling Green, KY 42102 |
Second Address | Bowling Green, KY 42102 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/10/2006 |
Last Update Date | 03/03/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
64203888 | (05) | KY |