Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PE0004X | Emergency Medical Services | 0101265987 | VA |
N | 208D00000X | General Practice Physician | 1003340381 | TX |
NPI | 1003340381 |
---|---|
Provider Name | Kole Holland Spaulding |
First Address | Jbsa Lackland Afb, TX 78236-5300 |
Second Address | Fort Sam Houston, TX 78234-4504 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/04/2017 |
Last Update Date | 05/10/2020 |