Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 34280 | KY |
Y | 111NI0900X | Internist | 34280 | KY |
N | 207RN0300X | Nephrologist | 34280 | KY |
NPI | 1023037082 |
---|---|
Provider Name | Mr. Rezkalla Butros |
First Address | Mt. Sterling, KY 40351-1300 |
Second Address | Mt. Sterling, KY 40351-1300 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2006 |
Last Update Date | 24/03/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
31-001050 | (05) | KY |
64015977 | (05) | KY |
65938888 | (05) | KY |
H24904 | (02) |