Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 20681 | KY |
NPI | 1053413179 |
---|---|
Provider Name | Manosh Vongvises |
First Address | Pikeville, KY 41501-1631 |
Second Address | Pikeville, KY 41501-1631 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/09/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
64206816 | (05) | KY |
C74243 | (02) | KY |