Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2086S0102X | Surgical Critical Care | 41321 | KY |
Y | 208G00000X | Cardiothoracic Vascular Surgeon | 41321 | KY |
NPI | 1295827921 |
---|---|
Provider Name | Joseph B Zwischenberger |
First Address | Lexington, KY 40536-0298 |
Second Address | Lexington, KY 40536-0298 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/09/2006 |
Last Update Date | 25/06/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
129740002 | (05) | TX |
D69321 | (02) | TX |