Individual
MR. MANOOCHEHR MAZLOOMDOOST
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
715 SHAKER DR, STE 101 PAIN MANAGEMENT MEDICINE, LEXINGTON, KY 40504
(859) 275-4878
(859) 276-5400
Mailing address
715 SHAKER DR, STE 101 PAIN MANAGEMENT MEDICINE, LEXINGTON, KY 40504
(859) 275-4878
(859) 276-5400
Taxonomy
Speciality
Code
Description
License number
State
208VP0000X
Pain Medicine Physician
Primary
17083
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000069094
BLUE CROSS BLUE SHIELD
KY
05
—
64170830
—
KY
Enumeration date
02/01/2006
Last updated
07/08/2007
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