Healthcare Provider Details

I. General information

NPI: 1740436054
Provider Name (Legal Business Name): OSCAR IGNACIO MORENO-PONTE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2008
Last Update Date: 01/04/2022
Certification Date: 01/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 ROSE ST RM C224
LEXINGTON KY
40536-7001
US

IV. Provider business mailing address

800 ROSE ST RM C224
LEXINGTON KY
40536-7001
US

V. Phone/Fax

Practice location:
  • Phone: 859-323-6346
  • Fax: 859-323-6840
Mailing address:
  • Phone: 859-323-6346
  • Fax: 859-323-6840

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License Number46266
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number46266
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: