Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204E00000X | Oral & Maxillofacial Surgeon | 38555 | AL |
NPI | 1184980195 |
---|---|
Provider Name | Brian Emory Kinard |
First Address | Birmingham, AL 35255-5309 |
Second Address | Birmingham, AL 35249-1013 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/04/2012 |
Last Update Date | 22/08/2019 |