Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 27332 | KY |
N | 208600000X | Surgeon | 27332 | KY |
Y | 2086X0206X | Surgical Oncologist | 27332 | KY |
NPI | 1457330094 |
---|---|
Provider Name | Kelly M Mcmasters |
First Address | Louisville, KY 40202-5700 |
Second Address | Louisville, KY 40202-5700 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/01/2006 |
Last Update Date | 30/07/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1051087 | PASSPORT (01) | KY |
200070640A | (05) | IN |
64273329 | (05) | KY |
F49030 | (02) |