Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207YS0123X | Facial Plastic Surgeon | ME92477 | FL |
Y | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 36944 | KY |
NPI | 1811959661 |
---|---|
Provider Name | Dr. Rudolph Joseph Triana JR. |
First Address | Mayfield, KY 42066-1194 |
Second Address | Mayfield, KY 42066-1194 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/04/2006 |
Last Update Date | 22/09/2014 |