Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | 20450 | KY |
N | 207Q00000X | Family Doctor | 20450 | KY |
NPI | 1003916842 |
---|---|
Provider Name | Lee Carter |
First Address | Glasgow, KY 42141-2244 |
Second Address | Glasgow, KY 42141-3454 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/09/2006 |
Last Update Date | 17/06/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
64204506 | (05) | KY |
C67471 | (02) |