Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223D0001X | Dental Public Health | 7646 | KY |
Y | 1223G0001X | General Practice | 7646 | KY |
Y | 213EG0000X | General Practice | 7646 | KY |
NPI | 1578789533 |
---|---|
Provider Name | Dr. William Kelley Cherry |
First Address | Bowling Green, KY 42104-8724 |
Second Address | Bowling Green, KY 42104-3245 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/04/2007 |
Last Update Date | 16/09/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
60000502 | (05) | KY |