Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | 31195 | KY |
N | 207ND0900X | Dermatopathologist | 31195 | KY |
N | 207NS0135X | Procedural Dermatology | 31195 | KY |
NPI | 1558364976 |
---|---|
Provider Name | Fernando R. De Castro |
First Address | Lexington, KY 40509-1888 |
Second Address | Lexington, KY 40509-1888 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/05/2005 |
Last Update Date | 17/12/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000044795 | ANTHEM (01) | |
0300072 | UNITED HEALTHCARE (01) | |
64311954 | (05) | KY |