Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | M8039 | TX |
NPI | 1659438778 |
---|---|
Provider Name | Keith J Hill |
First Address | Beaumont, TX 77707-2216 |
Second Address | Beaumont, TX 77707-2216 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/01/2007 |
Last Update Date | 17/11/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
187871201 | (05) | TX |
8J9356 | MEDICARE (01) | |
M8039 | STATE MEDICAL LICENSE (01) | TX |