Individual
BERNARD THEODORE BOTILLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1451 HARRODSBURG ROAD, SUITE D 304, LEXINGTON, KY 40504
(859) 977-4000
(859) 977-5100
Mailing address
6400 DUTCHMANS PKWY, SUITE 250, LOUISVILLE, KY 40205-3340
(502) 587-9660
(502) 540-5615
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA674
KY
363AM0700X
Medical Physician Assistant
PA674
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
95002739
—
KY
Enumeration date
08/09/2006
Last updated
05/24/2016
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