Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0106X | Orthopaedic Hand Surgeon | FT595 | KY |
NPI | 1265093496 |
---|---|
Provider Name | Mario A Almaraz |
First Address | Louisville, KY 40202-1858 |
Second Address | Louisville, KY 40202-1858 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/06/2019 |
Last Update Date | 27/06/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1255325304 | ORTHOPAEDIC SURGEON (01) | KY |
FT595 | LICENSE (01) | KY |