Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 25357 | KY |
NPI | 1619048139 |
---|---|
Provider Name | Mr. Frank Daniel Mongiardo |
First Address | Hazard, KY 41701-9466 |
Second Address | Hazard, KY 41701-9466 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/11/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
64253578 | (05) | KY |
B57913 | (02) | KY |