Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | ME109691 | FL |
Y | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | N7932 | TX |
NPI | 1518136225 |
---|---|
Provider Name | Dr. Kenneth Joseph Kaminski JR. |
First Address | Tyler, TX 75701-8336 |
Second Address | Tyler, TX 75701-8336 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/02/2008 |
Last Update Date | 21/01/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
003955300 | (05) | FL |