Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0100X | Gastroenterologist | L4028 | TX |
NPI | 1023093481 |
---|---|
Provider Name | Dr. Peter Raymond Kvapil |
First Address | Shenandoah, TX 77384-3001 |
Second Address | Shenandoah, TX 77384-3001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/12/2005 |
Last Update Date | 11/01/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0012MP | BCBS (01) | TX |
173634001 | (05) | TX |
I28821 | (02) | TX |
P00244586 | RAILROAD MEDICARE (01) | TX |