Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | 13044 | KY |
N | 207VX0000X | Obstetrician | 13044 | KY |
NPI | 1285654053 |
---|---|
Provider Name | Marvin Aaron Yussman |
First Address | Louisville, KY 40201-0909 |
Second Address | Louisville, KY 40202-5700 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/07/2006 |
Last Update Date | 11/04/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000047610 | ANTHEM (01) | KY |
100333900 | (05) | IN |
1049351 | PASSPORT PCP (01) | KY |
50004028 | PASSPORT SPECIALITY (01) | KY |
64130446 | (05) | KY |
C66536 | (02) | KY |