Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | 55547 | KY |
N | 207T00000X | Neurosurgeon | 57.021021 | OH |
N | 207T00000X | Neurosurgeon | TP065 | KY |
NPI | 1053667303 |
---|---|
Provider Name | Dr. David Lee Dornbos III |
First Address | Columbus, OH 43201-2462 |
Second Address | Lexington, KY 40536 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/07/2012 |
Last Update Date | 28/06/2021 |