Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RA0201X | Internist - Allergy & Immunology | 14589 | KY |
NPI | 1336147065 |
---|---|
Provider Name | Mr. Frank Gotham Simon |
First Address | Louisville, KY 40206-0418 |
Second Address | Louisville, KY 40207-4655 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2005 |
Last Update Date | 15/01/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
64145899 | (05) | KY |
C69841 | (02) | KY |