Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 24489 | TX |
NPI | 1104008861 |
---|---|
Provider Name | Dr. Travis W. Kern |
First Address | Austin, TX 78765-9500 |
Second Address | Austin, TX 78759 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/12/2007 |
Last Update Date | 07/12/2011 |