Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | P4660 | TX |
Y | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | P4660 | TX |
NPI | 1134353881 |
---|---|
Provider Name | Dr. Chad Matthew Kennedy |
First Address | Amarillo, TX 79106-1710 |
Second Address | Amarillo, TX 79106-0703 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/05/2009 |
Last Update Date | 11/12/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
387782YQXL | (02) | TX |