Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RA0401X | Internist - Addiction Medicine | 01079670A | IN |
Y | 207V00000X | Obstetrician & Gynecologist | 01079670A | IN |
NPI | 1962588574 |
---|---|
Provider Name | Robert L Mcquady JR. |
First Address | Charlestown, IN 47111-9535 |
Second Address | Jeffersonville, IN 47130-6016 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/10/2006 |
Last Update Date | 08/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01079670A | STATE LICENSE (01) | IN |
300010808 | (05) | IN |
C71829 | (02) | KY |
IN3604023 | MEDICARE PTAN (01) | IN |
K177821 | MEDICARE KY (01) | KY |