Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 20A18317 | CA |
Y | 207X00000X | Orthopaedic Surgeon | DO3008 | NV |
N | 207XP3100X | Pediatric Orthopaedic Surgeon | DO3008 | NV |
NPI | 1811383110 |
---|---|
Provider Name | Brock Todd Kitchen |
First Address | Las Vegas, NV 89128-4356 |
Second Address | Las Vegas, NV 89128-4356 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/04/2015 |
Last Update Date | 09/09/2021 |