Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2086S0129X | Vascular Surgeon | 35.093617 | OH |
Y | 2086S0129X | Vascular Surgeon | 40007 | KY |
NPI | 1083664254 |
---|---|
Provider Name | Dr. Omran Riad Abul-Khoudoud |
First Address | Ashland, KY 41105-2379 |
Second Address | Ashland, KY 41101-2878 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/05/2006 |
Last Update Date | 18/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000777096 | ANTHEM BCBS (01) | KY |
2645436 | (05) | OH |
3810006163 | (05) | WV |
64062821 | (05) | KY |
7499265 | AETNA (01) | KY |
H35148 | (02) | KY |