Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204F00000X | Transplant Surgeon | 40081 | KY |
N | 208200000X | Surgeon | 40081 | KY |
N | 208600000X | Surgeon | 40081 | KY |
NPI | 1710940879 |
---|---|
Provider Name | Mary Eng |
First Address | Louisville, KY 40201-0909 |
Second Address | Louisville, KY 40202-5700 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/04/2006 |
Last Update Date | 16/12/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200858590 | (05) | IN |
50012240 | PASSPORT (01) | KY |
64123698 | (05) | KY |
H88623 | (02) |