Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | KY23326 | KY |
N | 207QA0401X | Family Doctor - Addiction Medicine | 23326 | KY |
Y | 207RA0401X | Internist - Addiction Medicine | 23326 | KY |
NPI | 1982764551 |
---|---|
Provider Name | Mr. William T Fannin |
First Address | Prestonsburg, KY 41653-1721 |
Second Address | Pikeville, KY 41501 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/12/2006 |
Last Update Date | 13/12/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
64233265 | (05) | KY |
C66970 | (02) |