Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 27693 | KY |
Y | 2080P0204X | Pediatric Emergency Doctor | 27693 | KY |
NPI | 1083698021 |
---|---|
Provider Name | Ronald Irvin Paul |
First Address | Louisville, KY 40201-0909 |
Second Address | Louisville, KY 40202-1821 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/12/2005 |
Last Update Date | 04/09/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100376790 | (05) | IN |
64276934 | (05) | KY |
G05091 | (02) |