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Organization
KENTUCKIANA COLON AND RECTAL SURGERY, PLLC
Active
Organization
KENTUCKIANA COLON AND RECTAL SURGERY, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WAYNE TUCKSON MD (OWNER/PHYSICIAN)
(502) 583-8005
Entity
Organization
Contact information
Practice address
4121 DUTCHMANS LN, SUITE 515, LOUISVILLE, KY 40207-4737
(502) 583-8005
Mailing address
4121 DUTCHMANS LN, SUITE 515, LOUISVILLE, KY 40207-4737
(502) 583-8005
Taxonomy
Speciality
Code
Description
License number
State
208C00000X
Colon & Rectal Surgery Physician
Primary
30849
KY
363L00000X
Nurse Practitioner
—
NULL
363L00000X
Nurse Practitioner
—
—
Other
Enumeration date
07/06/2006
Last updated
08/13/2008
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