Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204E00000X | Oral & Maxillofacial Surgeon | 34451 | KY |
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 34451 | KY |
N | 207YX0007X | Plastic Surgeon (Head & Neck) | 34451 | KY |
NPI | 1912937939 |
---|---|
Provider Name | Wayne Brian Colin |
First Address | Lexington, KY 40504-2701 |
Second Address | Lexington, KY 40504-2701 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/07/2006 |
Last Update Date | 17/10/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
040016970 | RR MEDICARE PIN (01) | GA |
37903705 | MEDICAID LAB GROUP (01) | KY |
4000501 | MEDICARE LAB GROUP (01) | KY |
64345416 | (05) | KY |
CB5773 | RR MEDICARE GROUP (01) | GA |
E91753 | (02) |