Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VF0040X | Female Pelvic Medicine and Reconstructive Surgeon | 50803 | KY |
NPI | 1174839401 |
---|---|
Provider Name | Gerardo Manuel Heredia Melero |
First Address | Lexington, KY 40508-2678 |
Second Address | Lexington, KY 40508 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/08/2010 |
Last Update Date | 10/06/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
7100488350 | (05) | KY |