Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0201X | Pediatric Allergist | 54885 | KY |
NPI | 1336503259 |
---|---|
Provider Name | Roman Deniskin |
First Address | Pearland, TX 77584-5179 |
Second Address | Lexington, KY 40536 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/04/2016 |
Last Update Date | 14/06/2021 |