Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | 16950 | WV |
N | 207V00000X | Obstetrician & Gynecologist | 31309 | KY |
Y | 207VF0040X | Female Pelvic Medicine and Reconstructive Surgeon | 16950 | WV |
N | 207VF0040X | Female Pelvic Medicine and Reconstructive Surgeon | 31309 | KY |
NPI | 1073671673 |
---|---|
Provider Name | Kurt Jaenicke |
First Address | Huntington, WV 25701-3655 |
Second Address | Huntington, WV 25701-3655 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/12/2006 |
Last Update Date | 01/07/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000510048 | ANTHEM BCBS (01) | KY |
000000583794 | ANTHEM BCBS (01) | KY |
0163719 | (05) | OH |
64313091 | (05) | KY |