Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | TP729 | KY |
NPI | 1033228069 |
---|---|
Provider Name | Dr. Dana Black |
First Address | Lexington, KY 40509-2500 |
Second Address | Lexington, KY 40509-2500 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2006 |
Last Update Date | 27/05/2008 |