Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | M1812 | TX |
Y | 207XS0106X | Orthopaedic Hand Surgeon | M1812 | TX |
N | 2086S0105X | Surgery of the Hand | M1812 | TX |
NPI | 1831163690 |
---|---|
Provider Name | Charles F Kallina IV |
First Address | Dallas, TX 75284-4658 |
Second Address | Temple, TX 76508-3222 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/02/2006 |
Last Update Date | 26/10/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
180574901 | (05) | TX |
I36623 | (02) | TX |