Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VE0102X | Reproductive Endocrinologist | G2406 | TX |
NPI | 1013102904 |
---|---|
Provider Name | Dr. Keikhosrow M Kavoussi |
First Address | Austin, TX 78745 |
Second Address | Austin, TX 78745 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/09/2007 |
Last Update Date | 13/09/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C17741 | (02) | TX |