Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | 29164 | KY |
NPI | 1982674370 |
---|---|
Provider Name | Dr. Franklin O De La Cruz |
First Address | London, KY 40743-0936 |
Second Address | Bardstown, KY 40004-1142 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/01/2006 |
Last Update Date | 08/06/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1052134 | PASSPORT (01) | KY |
29164 | STATE LICENSE (01) | KY |
64291644 | (05) | KY |
F59150 | (02) | KY |