Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 16208 | KY |
N | 207Q00000X | Family Doctor | 34676 | OH |
NPI | 1003813759 |
---|---|
Provider Name | Milton Lee Brindley SR. |
First Address | Augusta, KY 41002-1037 |
Second Address | Augusta, KY 41002-1037 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0194936 | (05) | OH |
0862141 | VILLA GEORGETOWN EAGLE CR (01) | |
64162084 | (05) | KY |
C69852 | (02) |