1184742389 NPI number — ANDRES R AYOOB MD

Table of content: ANDRES R AYOOB MD (NPI 1184742389)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184742389 NPI number — ANDRES R AYOOB MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AYOOB
Provider First Name:
ANDRES
Provider Middle Name:
R
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1184742389
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/19/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
800 ROSE ST
Provider Second Line Business Mailing Address:
HX-315A
Provider Business Mailing Address City Name:
LEXINGTON
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40536-0293
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
859-323-2410
Provider Business Mailing Address Fax Number:
859-257-4457

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
800 ROSE ST
Provider Second Line Business Practice Location Address:
HX-315A
Provider Business Practice Location Address City Name:
LEXINGTON
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40536-0293
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-323-2410
Provider Business Practice Location Address Fax Number:
859-257-4457
Provider Enumeration Date:
03/26/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 390200000X , with the licence number:  4301081574 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0202X , with the licence number: 0101245669 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0202X , with the licence number: 43524 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2085B0100X , with the licence number: 42892 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1184742389 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7100125580 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".




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