Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207XS0106X | Orthopaedic Hand Surgeon | 01058351A | IN |
Y | 207XS0106X | Orthopaedic Hand Surgeon | 38401 | KY |
NPI | 1285628537 |
---|---|
Provider Name | Rodrigo Moreno |
First Address | Louisville, KY 40202-1846 |
Second Address | Louisville, KY 40202-1846 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/09/2005 |
Last Update Date | 23/08/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200502120A | (05) | IN |
64093230 | (05) | KY |
I08512 | (02) | KY |