Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | S6427 | TX |
NPI | 1073856399 |
---|---|
Provider Name | Matthew Kole |
First Address | Houston, TX 77030-1541 |
Second Address | Longview, TX 75601-5500 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/04/2013 |
Last Update Date | 02/09/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1S1994 | MCR (01) | TX |