Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | 38316 | KY |
Y | 207VE0102X | Reproductive Endocrinologist | 38316 | KY |
NPI | 1366475568 |
---|---|
Provider Name | Henry Cabot Lodge Bohler JR. |
First Address | Louisville, KY 40201-0909 |
Second Address | Louisville, KY 40202-5700 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/07/2006 |
Last Update Date | 15/11/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200463200 | (05) | IN |
64924855 | (05) | KY |