Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207VG0400X | Gynecologist | 02835 | KY |
Y | 207VX0000X | Obstetrician | 02835 | KY |
NPI | 1114912797 |
---|---|
Provider Name | Thomas Lewellen JR. |
First Address | Lexington, KY 40503-1431 |
Second Address | Lexington, KY 40503-1431 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2005 |
Last Update Date | 13/07/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
64077936 | (05) | KY |
G92357 | (02) | KY |