Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 36694 | KY |
Y | 207QA0401X | Family Doctor - Addiction Medicine | 36694 | KY |
NPI | 1689683658 |
---|---|
Provider Name | Dennis U Anciro |
First Address | Somerset, KY 42502 |
Second Address | Somerset, KY 42501 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/08/2006 |
Last Update Date | 05/12/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H82724 | (02) |