Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 31578 | KY |
Y | 111NI0900X | Internist | 31578 | KY |
N | 207RA0401X | Internist - Addiction Medicine | 31578 | KY |
NPI | 1447258553 |
---|---|
Provider Name | Mr. Jawed M Movania |
First Address | Elizabethtown, KY 42701-8940 |
Second Address | Radcliff, KY 40160-2604 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2005 |
Last Update Date | 26/04/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
64315781 | (05) | KY |
G23434 | (02) | KY |