Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | F9435 | TX |
NPI | 1245228550 |
---|---|
Provider Name | Mr. Kim Alan Foreman |
First Address | Tyler, TX 75713-0189 |
Second Address | Tyler, TX 75703-5469 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/10/2005 |
Last Update Date | 21/01/2015 |