Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207QA0401X | Family Doctor - Addiction Medicine | 39602 | KY |
N | 207QA0505X | Family Doctor - Adult Medicine | 39602 | KY |
N | 207QG0300X | Family Doctor - Geriatric Medicine | 39602 | KY |
N | 207QS0010X | Family Doctor - Sports Medicine | 39602 | KY |
NPI | 1285665562 |
---|---|
Provider Name | Diana Gascon |
First Address | Lexington, KY 40517-4012 |
Second Address | Lexington, KY 40536-0001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/07/2006 |
Last Update Date | 14/04/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
64106289 | (05) | KY |
I39853 | (02) |