Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207K00000X | Allergist & Immunologist | 01057648A | IN |
Y | 207K00000X | Allergist & Immunologist | 37904 | KY |
NPI | 1134129620 |
---|---|
Provider Name | Jason W. Guin |
First Address | Louisville, KY 40223-2992 |
Second Address | New Albany, IN 47150 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/07/2005 |
Last Update Date | 15/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200444210 | (05) | IN |
50001588 | PASSPORT (01) | KY |
64069198 | (05) | KY |
H88530 | (02) | |
H88530 | (02) | KY |