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General NPI Number Information
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NPI Number | 1083679260
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Entity Type | Individual
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Provider Name | DAVID J. OVERLEY M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/19/2006
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Last Update Date | 07/29/2014
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Provider Practice Location Address
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Address Line | 100 MALLARD CREEK RD STE. 320
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City | LOUISVILLE
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State | KY
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Zip | 40207-4194
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Country | US
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Telephone | 502-855-6125
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Fax | 502-394-1972
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Provider Business Mailing Address
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Address Line | PO BOX 950202
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City | LOUISVILLE
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State | KY
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Zip | 40295-0202
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Country | US
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Telephone | 502-588-9490
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 28046
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License Number State | KY
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