Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0122X | Plastic and Reconstructive Surgery | 12399 | AL |
NPI | 1235151424 |
---|---|
Provider Name | Luis O Vasconez |
First Address | Birmingham, AL 35255-5310 |
Second Address | Birmingham, AL 35233 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/07/2006 |
Last Update Date | 28/05/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000014647 | (05) | AL |
000014647 | BLUE CROSS (01) | AL |
009932092 | (05) | AL |
051529687 | BLUE CROSS (01) | AL |
A47233 | VIVA (01) | AL |