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NPI Code Detail

MEDICARE: JONATHAN KEITH AUERBACH M.D.

MEDICARE: JONATHAN KEITH AUERBACH M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12084P0800XPsychiatry Physician21973KY

General Provider Information

NPI Number : 1114078425
Entity Type Code : Individual
Provider Name (Legal Business Name) : JONATHAN KEITH AUERBACH M.D.
Provider Business Mailing Address
First Line : 1175 E BROADWAY
Second Line :
City : LOUISVILLE
State : KY
Zip : 40204-1711
Country : US
Telephone Number : 502-589-6433
Fax Number : 502-589-6434
Provider Business Practice Location Address
First Line : 1175 E BROADWAY
Second Line :
City : LOUISVILLE
State : KY
Zip : 40204-1711
Country : US
Telephone Number : 502-589-6433
Fax Number : 502-589-6434
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/15/2007
Last Update Date : 07/08/2007

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