Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111N00000X | Chiropractor | 12872 | FL |
N | 111N00000X | Chiropractor | 1811 | LA |
N | 111N00000X | Chiropractor | TX8323 | TX |
Y | 111NN0400X | Neurology | 8323 | TX |
N | 111NR0200X | Radiology | 8323 | TX |
N | 213ER0200X | Radiology | 8323 | TX |
N | 111NX0100X | Occupational Health | 8323 | TX |
NPI | 1598752545 |
---|---|
Provider Name | Kirt W Repp |
First Address | The Woodlands, TX 77387-6973 |
Second Address | Pasadena, TX 77504-1859 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/10/2005 |
Last Update Date | 11/11/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8P5801 | BLUE CROSS BLUE SHIELD (01) | TX |
V02179 | (02) | TX |