=====================================================
General NPI Number Information
=====================================================
NPI Number | 1629099528
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ROSS TODD HOCKENBURY M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/23/2006
-----------------------------------------------------
Last Update Date | 05/22/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4402 CHURCHMAN AVE SUITE 300
-----------------------------------------------------
City | LOUISVILLE
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40215-1190
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 502-363-0588
-----------------------------------------------------
Fax | 502-363-0761
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6801 DIXIE HWY SUITE 130
-----------------------------------------------------
City | LOUISVILLE
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40258-3913
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 502-363-0588
-----------------------------------------------------
Fax | 502-363-0972
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207X00000X
-----------------------------------------------------
Taxonomy Name | Orthopaedic Surgery Physician
-----------------------------------------------------
License Number | 24906
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------