Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | AT1604 | KY |
NPI | 1013598606 |
---|---|
Provider Name | Tyrone Gregory Dozier JR. |
First Address | Berea, KY 40403-9616 |
Second Address | Richmond, KY 40475-8687 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/04/2021 |
Last Update Date | 16/04/2021 |