Basic Information
| Provider Information | |||||||||
| NPI: | 1598859464 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WORKMAN | ||||||||
| FirstName: | MARC | ||||||||
| MiddleName: | ALAN | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 412 N LOCK AVE | ||||||||
| Address2: | |||||||||
| City: | LOUISA | ||||||||
| State: | KY | ||||||||
| PostalCode: | 41230 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6066384595 | ||||||||
| FaxNumber: | 6066389471 | ||||||||
| Practice Location | |||||||||
| Address1: | 412 N LOCK AVE | ||||||||
| Address2: | |||||||||
| City: | LOUISA | ||||||||
| State: | KY | ||||||||
| PostalCode: | 41230 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6066384595 | ||||||||
| FaxNumber: | 6066389471 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/03/2006 | ||||||||
| LastUpdateDate: | 02/19/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 26631 | KY | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 64266315 | 05 | KY | MEDICAID |