Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207P00000X | Emergency Physician | 13780 | KY |
NPI | 1013055920 |
---|---|
Provider Name | Larry Hall |
First Address | Mayfield, KY 42066-0016 |
Second Address | Fulton, KY 42041-8468 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/02/2007 |
Last Update Date | 29/01/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000337173 | BCBS (01) | |
64137805 | (05) | KY |
C70237 | (02) | KY |
P00132977 | RR MCR (01) |