Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | 45932 | KY |
N | 207N00000X | Dermatologist | ME107728 | FL |
NPI | 1043444219 |
---|---|
Provider Name | Dr. Tandy Sutton Repass |
First Address | Lexington, KY 40509-1888 |
Second Address | Lexington, KY 40509-1888 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/05/2009 |
Last Update Date | 14/10/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
003894900 | (05) | FL |
FK836Z | (02) | FL |
K110040 | (02) | KY |