Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0122X | Plastic and Reconstructive Surgery | 18215 | KY |
N | 208D00000X | General Practice Physician | 18215 | KY |
NPI | 1255837696 |
---|---|
Provider Name | Dr. Edgar A. Lopez-Suescum |
First Address | Louisville, KY 40206-1447 |
Second Address | Louisville, KY 40206-1447 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/04/2018 |
Last Update Date | 04/04/2018 |