Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 37369 | KY |
N | 207QS0010X | Family Doctor - Sports Medicine | 37369 | KY |
NPI | 1235132333 |
---|---|
Provider Name | Jonathan A Becker |
First Address | Louisville, KY 40202-1785 |
Second Address | Louisville, KY 40202-2040 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/05/2005 |
Last Update Date | 12/01/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200533690 | (05) | IN |
64050321 | (05) | KY |
H65569 | (02) | KY |