Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 01044027A | IN |
Y | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | 01044027A | IN |
NPI | 1083621304 |
---|---|
Provider Name | Thomas H Ledyard |
First Address | Indianapolis, IN 46250-2805 |
Second Address | Indianapolis, IN 46219-3027 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/08/2006 |
Last Update Date | 01/09/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000642510 | ANTHEM (01) | IN |
100369630 | (05) | IN |
7444620 | AETNA (01) | IN |
G19851 | (02) | IN |