Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0103X | Foot & Ankle Surgery | PO3007 | FL |
NPI | 1023076312 |
---|---|
Provider Name | Dr. Kyle J Kinmon |
First Address | Boca Raton, FL 33487-5714 |
Second Address | Boca Raton, FL 33487-2768 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/05/2006 |
Last Update Date | 24/04/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
340310600 | (05) | FL |
65766Y | MEDICARE NUMBER (01) | FL |
U91103 | (02) | FL |