Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | H3398 | TX |
N | 207XS0106X | Orthopaedic Hand Surgeon | H3398 | TX |
N | 207XS0117X | Orthopaedic Spine Surgeon | H3398 | TX |
N | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | H3398 | TX |
NPI | 1447331665 |
---|---|
Provider Name | Larry M Kjeldgaard |
First Address | Hurst, TX 76054-3289 |
Second Address | Hurst, TX 76054-3289 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/10/2006 |
Last Update Date | 11/07/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E46320 | (02) | TX |