Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 7712 | KY |
N | 204E00000X | Oral & Maxillofacial Surgeon | 7712 | KY |
NPI | 1205853124 |
---|---|
Provider Name | Dr. Gregory A Cobetto |
First Address | Lexington, KY 40536-0297 |
Second Address | Lexington, KY 40536-0297 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/07/2006 |
Last Update Date | 23/03/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0037858 | MEDICARE PTAN (01) | KY |
60003175 | (05) | KY |
64031842 | (05) | KY |
U84874 | (02) | KY |