Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | 46375 | KY |
NPI | 1003929217 |
---|---|
Provider Name | Samuel B Kriegler |
First Address | Lebanon, KY 40033-1628 |
Second Address | Lebanon, KY 40033-1628 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/08/2006 |
Last Update Date | 27/06/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
163D2KR | BCBS (01) | MN |
324504700 | (05) | MN |