Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RE0101X | Endocrinologist (Diabetes Doctor) | M1861 | TX |
NPI | 1083641534 |
---|---|
Provider Name | Maxwell Prosper Kwaku |
First Address | Tyler, TX 75711-9477 |
Second Address | Tyler, TX 75701 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/06/2006 |
Last Update Date | 08/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I36902 | (02) | |
P00229235 | MEDICARE RR (01) |