Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2080P0202X | Pediatric Cardiologist | 35128385 | OH |
Y | 2080P0202X | Pediatric Cardiologist | 39922 | KY |
NPI | 1235155433 |
---|---|
Provider Name | Louis Irving Bezold III |
First Address | Lexington, KY 40536-0001 |
Second Address | Lexington, KY 40536 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/07/2006 |
Last Update Date | 10/07/2018 |