Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0122X | Plastic and Reconstructive Surgery | 21531 | KY |
NPI | 1093717274 |
---|---|
Provider Name | Dr. Joseph C. Banis JR. |
First Address | Louisville, KY 40245-5885 |
Second Address | Louisville, KY 40245-5885 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/06/2005 |
Last Update Date | 07/05/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C66399 | (02) | KY |