Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | 6460 | TX |
NPI | 1811946940 |
---|---|
Provider Name | Kevin L. Mcnabb |
First Address | Kilgore, TX 75662-3546 |
Second Address | Kilgore, TX 75662-3546 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/05/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
20687-001 | (05) | TX |
605939 | (02) | TX |