Individual
SHANE TIMOTHY DESIMONE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
202-206 MILBY STREET, GREENSBURG, KY 42743
(270) 932-4211
(270) 299-2041
Mailing address
PO BOX 220, GREENSBURG, KY 42743-0220
(270) 932-4211
(270) 299-2041
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
43280
KY
2085R0202X
Diagnostic Radiology Physician
T2005018779
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100126300
—
KY
Enumeration date
09/01/2006
Last updated
12/20/2011
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