Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2082S0105X | Plastic Hand Surgeon | 01044787A | IN |
Y | 2082S0105X | Plastic Hand Surgeon | 23092 | KY |
NPI | 1023002359 |
---|---|
Provider Name | Warren C Breidenbach |
First Address | Louisville, KY 40202-1846 |
Second Address | Louisville, KY 40202-1846 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/09/2005 |
Last Update Date | 08/05/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100356120A | (05) | IN |
64230923 | (05) | KY |
C67930 | (02) | KY |