Individual
GOUTHAM HEBBALMATH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
57 SUMMIT DR, CORBIN, KY 40701-2746
(606) 528-9700
(606) 528-8423
Mailing address
57 SUMMIT DR, CORBIN, KY 40701-2746
(606) 528-9700
(606) 528-8423
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
46189
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100256410
—
KY
Enumeration date
09/22/2010
Last updated
09/08/2016
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