Individual
BRION WAIN ROMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1 MEDICAL VILLIAGE DR, INDEPENDENT ANESTHESIOLOGISTS PSC, EDGEWOOD, KY 41017
(859) 341-7246
(859) 341-7867
Mailing address
20 MEDICAL VILLAGE DR, STE 258, EDGEWOOD, KY 41017
(859) 341-7246
(859) 341-7867
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
38181
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000288560
ANTHEM BLUE SHIELD
—
01
—
11319897
CAQH
—
01
—
2413883
MEDICAID
OH
05
—
64065972
—
KY
01
—
7168540
AETNA
—
Enumeration date
11/07/2005
Last updated
02/20/2008
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