Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | TRN6843 | FL |
Y | 207XS0117X | Orthopaedic Spine Surgeon | M8573 | TX |
NPI | 1063596997 |
---|---|
Provider Name | Dr. Kendall Edward Carll II |
First Address | Plano, TX 75025-4013 |
Second Address | Plano, TX 75025 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/10/2006 |
Last Update Date | 05/02/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8BW305 | BCBS PIN (01) | TX |
P00697462 | RAIL ROAD MEDICARE (01) | TX |