Individual
BRENT E. MCENTIRE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4420 DIXIE HWY, STE. 114, LOUISVILLE, KY 40216-2988
(502) 449-6464
(502) 449-6465
Mailing address
PO BOX 950202, LOUISVILLE, KY 40295-0202
(502) 588-9490
(502) 272-5116
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
35588
KY
208000000X
Pediatrics Physician
35588
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000194158
BCBS PROVIDER NUMBER
—
01
—
35588
LICENSE
KY
05
—
64018401
—
KY
Enumeration date
09/16/2006
Last updated
11/12/2014
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