Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2086S0129X | Vascular Surgeon | 01046196 | IN |
Y | 2086S0129X | Vascular Surgeon | 24711 | KY |
NPI | 1174557037 |
---|---|
Provider Name | Stephen Bender Self |
First Address | Louisville, KY 40202-1434 |
Second Address | Louisville, KY 40202 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/07/2006 |
Last Update Date | 27/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100389000A-KOHMG | (05) | IN |
64247117 | (05) | KY |
C71196 | (02) |