Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 10512 | KY |
N | 207QA0401X | Family Doctor - Addiction Medicine | 10512 | KY |
N | 207QA0505X | Family Doctor - Adult Medicine | 10512 | KY |
N | 207QG0300X | Family Doctor - Geriatric Medicine | 10512 | KY |
N | 207QS0010X | Family Doctor - Sports Medicine | 10512 | KY |
NPI | 1023053147 |
---|---|
Provider Name | Ellsworth Carl Seeley |
First Address | Lexington, KY 40536-0001 |
Second Address | Lexington, KY 40536-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/06/2006 |
Last Update Date | 27/03/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
64105125 | (05) | KY |
C65270 | (02) |