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General NPI Number Information
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NPI Number | 1790797702
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Entity Type | Organization
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Legal Business Name | E TOWN LUNG SPECIALIST PSC
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Dates
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Enumeration Date | 08/12/2006
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Last Update Date | 08/11/2025
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Provider Practice Location Address
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Address Line | 914 N DIXIE AVE
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City | ELIZABETHTOWN
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State | KY
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Zip | 42701-2520
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Country | US
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Telephone | 270-735-9066
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Fax | 270-735-9036
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Provider Business Mailing Address
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Address Line | 914 N DIXIE AVE
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City | ELIZABETHTOWN
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State | KY
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Zip | 42701-2520
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Country | US
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Telephone | 270-735-9066
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Fax | 270-735-9036
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Authorized Official
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Title or Position | MEDICAL DOCTOR
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Name | AIJAZ A YAZDANI
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Credential | MD
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Telephone | 270-735-9066
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number |
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License Number State |
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