Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RH0003X | Hematology & Oncology | 21275 | KY |
NPI | 1063557353 |
---|---|
Provider Name | Polly A Coombs |
First Address | Louisville, KY 40202-1434 |
Second Address | Louisville, KY 40202-1434 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/02/2007 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E01361 | (02) | KY |