Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 5386 | KY |
Y | 204E00000X | Oral & Maxillofacial Surgeon | 5386 | KY |
NPI | 1245386812 |
---|---|
Provider Name | Mr. William R Anderson |
First Address | Paintsville, KY 41240 |
Second Address | Pikeville, KY 41501 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/01/2007 |
Last Update Date | 22/04/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
60053865DENTAL | MEDICAID (01) | KY |
6405386MEDICAL | (05) | KY |
T54111 | (02) |