| NPI | 1619908613 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WAYNE TUCKSON Owner/Physician 502-583-8005 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: KY 30849) |
| Additional Taxonomies | 363L00000X Nurse Practitioner |
| Enumeration Date | 2006-07-06 |
| Last Update Date | 2008-08-13 |