Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207VG0400X | Gynecologist | 33954 | KY |
N | 207VX0000X | Obstetrician | 33954 | KY |
Y | 207VX0201X | Gynecologic Oncologist | 33954 | KY |
NPI | 1538103056 |
---|---|
Provider Name | Christopher Phillip Desimone |
First Address | Lexington, KY 40508-3215 |
Second Address | Lexington, KY 40536-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/06/2006 |
Last Update Date | 11/12/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
64185424 | (05) | KY |
C78378 | (02) |