Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 32582 | KY |
Y | 207QG0300X | Family Doctor - Geriatric Medicine | 32582 | KY |
NPI | 1063463917 |
---|---|
Provider Name | James Gerard O'brien |
First Address | Louisville, KY 40202-1785 |
Second Address | Louisville, KY 40208-1449 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/05/2006 |
Last Update Date | 31/03/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200113250 | (05) | IN |
64325822 | (05) | KY |