Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | 4301062066 | MI |
N | 207VG0400X | Gynecologist | 4301062066 | MI |
N | 207VX0000X | Obstetrician | 4301062066 | MI |
NPI | 1215971189 |
---|---|
Provider Name | Dr. William Blake Kutsche |
First Address | Pecos, TX 79772-7338 |
Second Address | Pecos, TX 79772-7338 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/06/2006 |
Last Update Date | 21/01/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
4876421 | (05) | MI |
4876600 | (05) | MI |
B69580 | (02) | MI |
ECFMG | 03691540 (01) |