Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 25551 | KY |
N | 208600000X | Surgeon | 25551 | KY |
N | 2082S0105X | Plastic Hand Surgeon | 25551 | KY |
Y | 2086S0122X | Plastic and Reconstructive Surgery | 25551 | KY |
NPI | 1861458705 |
---|---|
Provider Name | Henry Carlos Vasconez |
First Address | Lexington, KY 40517-4012 |
Second Address | Lexington, KY 40536-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/04/2006 |
Last Update Date | 10/06/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
64255516 | (05) | KY |
C66105 | (02) |