Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | 49242 | KY |
N | 207L00000X | Anesthesiologist | LL34900 | SC |
NPI | 1003179961 |
---|---|
Provider Name | Gregory Scott Kottkamp |
First Address | Lexington, KY 40503-3590 |
Second Address | Somerset, KY 42503-2750 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/06/2012 |
Last Update Date | 06/07/2016 |