Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | 28215 | KY |
NPI | 1003821810 |
---|---|
Provider Name | Mrs. Jyoti B. Burruss |
First Address | Louisville, KY 40295-0132 |
Second Address | Louisville, KY 40241 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/07/2006 |
Last Update Date | 17/07/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100462680 | (05) | IN |
64282155 | (05) | KY |
F64016 | (02) |