Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | L7525 | TX |
N | 207YX0007X | Plastic Surgeon (Head & Neck) | L7525 | TX |
NPI | 1285632679 |
---|---|
Provider Name | Dr. Kellous Andrew Price |
First Address | College Station, TX 77842-0194 |
Second Address | College Station, TX 77845-4063 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2005 |
Last Update Date | 16/09/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
160418301 | (05) | TX |
G80387 | (02) | TX |