Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0106X | Orthopaedic Hand Surgeon | FT634 | KY |
NPI | 1265004154 |
---|---|
Provider Name | Abel Herrera |
First Address | Louisville, KY 40202-3840 |
Second Address | Louisville, KY 40202-3840 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2021 |
Last Update Date | 12/07/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
FT634 | STATE LICENSURE (01) | KY |