Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 15864 | KY |
N | 207QA0401X | Family Doctor - Addiction Medicine | 15864 | KY |
N | 207QA0401X | Family Doctor - Addiction Medicine | 35.123032 | OH |
NPI | 1235131699 |
---|---|
Provider Name | William S Foley JR. |
First Address | Versailles, KY 40383-1223 |
Second Address | Versailles, KY 40383-1223 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/08/2005 |
Last Update Date | 20/11/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
64158645 | (05) | KY |
C63290 | (02) |