Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 37083 | KY |
N | 207QA0401X | Family Doctor - Addiction Medicine | 37083 | KY |
N | 207QA0505X | Family Doctor - Adult Medicine | 37083 | KY |
N | 207QG0300X | Family Doctor - Geriatric Medicine | 37083 | KY |
N | 207QS0010X | Family Doctor - Sports Medicine | 37083 | KY |
NPI | 1760412332 |
---|---|
Provider Name | Guy Huet Roussel |
First Address | Lexington, KY 40508-3215 |
Second Address | Lexington, KY 40536-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
64046279 | (05) | KY |
B86283 | (02) |