Provider Demographics
NPI:1548717382
Name:VAUBOURG MANHEIM, MARIE-FRANCE
Entity type:Individual
Prefix:
First Name:MARIE-FRANCE
Middle Name:
Last Name:VAUBOURG MANHEIM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:523 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40422-1924
Mailing Address - Country:US
Mailing Address - Phone:859-319-2712
Mailing Address - Fax:
Practice Address - Street 1:129 S WINTER ST
Practice Address - Street 2:
Practice Address - City:MIDWAY
Practice Address - State:KY
Practice Address - Zip Code:40347-5002
Practice Address - Country:US
Practice Address - Phone:859-846-4445
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-09
Last Update Date:2016-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYF0514059207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine