Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 7116 | KY |
NPI | 1053312066 |
---|---|
Provider Name | Richard A Pape |
First Address | Louisville, KY 40220-2742 |
Second Address | Louisville, KY 40220-2742 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/08/2005 |
Last Update Date | 09/01/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1141783 | PASSPORT (01) | KY |
60000783 | MEDICAID - DENTAL (01) | KY |
64029069 | (05) | KY |
U84160 | (02) |