Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | 4616 | TX |
NPI | 1346461498 |
---|---|
Provider Name | Dr. Kenneth Karl Tyer JR. |
First Address | Kingwood, TX 77345 |
Second Address | Pasadena, TX 77505-1699 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/05/2007 |
Last Update Date | 09/07/2007 |