Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 14812 | KY |
N | 207QA0401X | Family Doctor - Addiction Medicine | 14812 | KY |
N | 207QA0505X | Family Doctor - Adult Medicine | 14812 | KY |
N | 207QG0300X | Family Doctor - Geriatric Medicine | 14812 | KY |
N | 207QS0010X | Family Doctor - Sports Medicine | 14812 | KY |
NPI | 1932137478 |
---|---|
Provider Name | Samuel Coleman Matheny |
First Address | Lexington, KY 40517-4012 |
Second Address | Lexington, KY 40536-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/06/2006 |
Last Update Date | 14/04/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
64148125 | (05) | KY |
A87550 | (02) |