Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | 226 | KY |
N | 222Z00000X | Podiatrist | 226 | KY |
N | 213ES0131X | Foot Surgery | 226 | KY |
NPI | 1376630780 |
---|---|
Provider Name | Deoborah Photos |
First Address | Lexington, KY 40502-2235 |
Second Address | Lexington, KY 40502-2235 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/10/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
80002264 | (05) | KY |
U57248 | (02) | KY |