Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 42746 | KY |
N | 207QA0401X | Family Doctor - Addiction Medicine | 42746 | KY |
NPI | 1801059399 |
---|---|
Provider Name | Jesus Victor Tovar |
First Address | Lexington, KY 40517-4010 |
Second Address | Lexington, KY 40517-4010 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/07/2008 |
Last Update Date | 21/04/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
42746 | MEDICAL LICENSE (01) | KY |
FT1296549 | DEA LICENSE (01) |