Healthcare Provider Details

I. General information

NPI: 1770623878
Provider Name (Legal Business Name): ENDOCRINE ASSOCIATES PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 04/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3906 S DUPONT SQ
LOUISVILLE KY
40207-4647
US

IV. Provider business mailing address

3906 S DUPONT SQ
LOUISVILLE KY
40207-4647
US

V. Phone/Fax

Practice location:
  • Phone: 502-895-8218
  • Fax: 502-895-8219
Mailing address:
  • Phone: 502-895-8218
  • Fax: 502-895-8219

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number
License Number StateKY

VIII. Authorized Official

Name: DONALD G WOOD
Title or Position: OWNER
Credential: MD
Phone: 502-895-8218