Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 46770 | KY |
N | 111NI0900X | Internist | 46770 | KY |
Y | 207RR0500X | Rheumatology | 46770 | KY |
NPI | 1003162546 |
---|---|
Provider Name | Dr. Indhira Bisono Jimenez |
First Address | London, KY 40743-0936 |
Second Address | Lexington, KY 40509-2694 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/08/2012 |
Last Update Date | 06/05/2019 |