Healthcare Provider Details

I. General information

NPI: 1093763583
Provider Name (Legal Business Name): MARION D EYRE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2006
Last Update Date: 12/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6420 DUTCHMANS PKWY SUITE 380
LOUISVILLE KY
40205-3372
US

IV. Provider business mailing address

6420 DUTCHMANS PKWY SUITE 380
LOUISVILLE KY
40205-3372
US

V. Phone/Fax

Practice location:
  • Phone: 502-894-9753
  • Fax: 502-371-0929
Mailing address:
  • Phone: 502-894-9753
  • Fax: 502-371-0929

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number35997
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number01053627A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: