Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 25291 | KY |
NPI | 1033112206 |
---|---|
Provider Name | John T Burch |
First Address | Bowling Green, KY 42101-1759 |
Second Address | Bowling Green, KY 42103-7940 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/05/2005 |
Last Update Date | 09/08/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
64252919 | (05) | KY |
C63412 | (02) | KY |