Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 0101046916 | VA |
N | 2080N0001X | Neonatal-Perinatal Doctor | 0101046916 | VA |
Y | 2080N0001X | Neonatal-Perinatal Doctor | Q2875 | TX |
NPI | 1033188024 |
---|---|
Provider Name | Kevin B Al-Mateen |
First Address | Spring, TX 77379-7746 |
Second Address | Spring, TX 77379-7746 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/03/2006 |
Last Update Date | 06/01/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
010072301 | (05) | VA |
342573802 | (05) | TX |
F27909 | (02) |