Healthcare Provider Details

I. General information

NPI: 1437480399
Provider Name (Legal Business Name): EDDIE SIZEMORE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/15/2010
Last Update Date: 02/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 KATE IRELAND DR
HYDEN KY
41749-9071
US

IV. Provider business mailing address

130 KATE IRELAND DR
HYDEN KY
41749-9071
US

V. Phone/Fax

Practice location:
  • Phone: 606-672-1127
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberR1627
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: