Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207K00000X | Allergist & Immunologist | 01027931A | IN |
Y | 207K00000X | Allergist & Immunologist | 18715 | KY |
NPI | 1043204548 |
---|---|
Provider Name | James L Sublett |
First Address | Louisville, KY 40223-2992 |
Second Address | Louisville, KY 40223-2992 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/09/2005 |
Last Update Date | 26/05/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100354390 | (05) | IN |
1049059 | PASSPORT PROVIDER NUMBER (01) | KY |
64187156 | (05) | KY |
C74000 | (02) | KY |