Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | H4534 | TX |
N | 207YX0007X | Plastic Surgeon (Head & Neck) | H4534 | TX |
NPI | 1679656250 |
---|---|
Provider Name | Dr. Conrad Kyle Mccutcheon |
First Address | Houston, TX 77024-1624 |
Second Address | Houston, TX 77024-1624 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/10/2006 |
Last Update Date | 03/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8A2492 | BLUE CROSS BLUE SHIELD (01) | TX |
F26649 | (02) |