Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 36431 | KY |
NPI | 1003802497 |
---|---|
Provider Name | Mr. David E James |
First Address | Bowling Green, KY 42104-7855 |
Second Address | Bowling Green, KY 42104-7855 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/09/2005 |
Last Update Date | 03/03/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
64037575 | (05) | KY |
H51497 | (02) |