Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 16446 | KY |
NPI | 1083682892 |
---|---|
Provider Name | John D Loucks |
First Address | Owensboro, KY 42303-1320 |
Second Address | Owensboro, KY 42303-1320 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/03/2006 |
Last Update Date | 17/03/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C72192 | (02) | KY |