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Individual

DR. BRIAN LOUIS MATTINGLY

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
530 S JACKSON ST # C07, LOUISVILLE, KY 40202-1675
(502) 852-5875
Mailing address
PO BOX 909, LOUISVILLE, KY 40201-0909

Taxonomy

Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
01070895A
IN
2085R0202X
Diagnostic Radiology Physician
11013730A
IN
2085R0202X
Diagnostic Radiology Physician
Primary
45959
KY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
201061080
IN
05
7100241190
KY
01
P01119551
RAILROAD MEDICARE
IN
Enumeration date
05/19/2008
Last updated
02/14/2020
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