Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 38909 | KY |
N | 207QA0401X | Family Doctor - Addiction Medicine | 38909 | KY |
N | 207QA0505X | Family Doctor - Adult Medicine | 38909 | KY |
N | 207QG0300X | Family Doctor - Geriatric Medicine | 38909 | KY |
Y | 207QS0010X | Family Doctor - Sports Medicine | 38909 | KY |
N | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 38909 | KY |
NPI | 1881622751 |
---|---|
Provider Name | Kyle Douglas Parish |
First Address | Paducah, KY 42003-7913 |
Second Address | Paducah, KY 42003-7913 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/06/2006 |
Last Update Date | 20/04/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
64107030 | (05) | KY |
I39734 | (02) | KY |