Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | 48389 | KY |
NPI | 1063730372 |
---|---|
Provider Name | Dustin Todd Gayheart |
First Address | Pikeville, KY 41502-0432 |
Second Address | Pikeville, KY 41501-1689 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/05/2010 |
Last Update Date | 28/04/2021 |