Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0106X | Orthopaedic Hand Surgeon | FT582 | KY |
NPI | 1003302316 |
---|---|
Provider Name | Dr. Jose Javier Banda Mendoza |
First Address | Louisville, KY 40202-1858 |
Second Address | Louisville, KY 40202-1858 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/07/2018 |
Last Update Date | 10/07/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
FT582 | MEDICAL LICENSE (01) | KY |