Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | BK3779 | TX |
NPI | 1003806803 |
---|---|
Provider Name | Jonathan J Kral |
First Address | Longview, TX 75601-5580 |
Second Address | Longview, TX 75601-5580 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/10/2005 |
Last Update Date | 10/11/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
104585801 | (05) | TX |
G14405 | (02) | TX |