Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223G0001X | General Practice | 9451 | KY |
N | 213EG0000X | General Practice | 9451 | KY |
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 9451 | KY |
NPI | 1033524871 |
---|---|
Provider Name | Dr. Travis Mcmaine |
First Address | Lexington, KY 40536-0293 |
Second Address | Lexington, KY 40536-0293 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/06/2014 |
Last Update Date | 01/08/2017 |