Individual
DR. BRIAN T ODONOGHUE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
107 OLD HIGHWAY 60, HARDINSBURG, KY 40143-2501
(270) 580-2250
Mailing address
107 OLD HIGHWAY 60, HARDINSBURG, KY 40143-2501
(270) 580-2250
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
32124
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000066552
ANTHEM
KY
01
—
1072079
PASSPORT
KY
05
—
65900656
—
KY
Enumeration date
07/21/2005
Last updated
01/28/2020
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