Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 6273 | KY |
Y | 213EG0000X | General Practice | 6273 | KY |
NPI | 1003028036 |
---|---|
Provider Name | John T Isaacs JR. |
First Address | Springfield, KY 40069-1520 |
Second Address | Springfield, KY 40069-1516 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/05/2007 |
Last Update Date | 08/07/2007 |