Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | 30518 | KY |
NPI | 1194719831 |
---|---|
Provider Name | John P Oliphant |
First Address | Louisville, KY 40220-5437 |
Second Address | Louisville, KY 40220-5437 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/09/2005 |
Last Update Date | 24/02/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000052171 | ANTHEM (01) | |
1124739 | PASSPORT (01) | |
1200353 | UNITED HEALTHCARE (01) |