Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223P0106X | Oral and Maxillofacial Pathology | 13358 | TX |
N | 1223S0112X | Oral and Maxillofacial Surgeon | 13358 | TX |
Y | 204E00000X | Oral & Maxillofacial Surgeon | 13358 | TX |
NPI | 1295776011 |
---|---|
Provider Name | Dr. Steven F Kolb |
First Address | Sherman, TX 75092-3424 |
Second Address | Sherman, TX 75092-3424 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/06/2006 |
Last Update Date | 13/07/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
110904303 | (05) | TX |
190009680 | RR MDCR (01) | |
84D156 | BCBS (01) | |
T14247 | (02) |