Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223E0200X | Endodontist | 4988 | KY |
Y | 1223G0001X | General Practice | 4988 | KY |
Y | 213EG0000X | General Practice | 4988 | KY |
NPI | 1003907015 |
---|---|
Provider Name | Timothy J Mcmahon |
First Address | Dry Ridge, KY 41035 |
Second Address | Dry Ridge, KY 41035 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/09/2006 |
Last Update Date | 05/04/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
60049889 | (05) | KY |