Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | R6065 | TX |
NPI | 1013301944 |
---|---|
Provider Name | Kenneth Nugent |
First Address | San Antonio, TX 78231-1895 |
Second Address | San Antonio, TX 78229-3902 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/03/2015 |
Last Update Date | 09/12/2019 |