MEDICARE: DR. KYLE PATRICK MCMORRIES M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program
2	207V00000X	Obstetrics & Gynecology Physician	N0964	TX

General Provider Information

NPI Number	:	1184882581
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KYLE PATRICK MCMORRIES M.D.

Provider Business Mailing Address
First Line	:	4710 NE STALLINGS DR
Second Line	:
City	:	NACOGDOCHES
State	:	TX
Zip	:	75965-1615
Country	:	US
Telephone Number	:	936-560-2666
Fax Number	:

Provider Business Practice Location Address
First Line	:	4710 NE STALLINGS DR
Second Line	:
City	:	NACOGDOCHES
State	:	TX
Zip	:	75965-1615
Country	:	US
Telephone Number	:	936-560-2666
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/02/2008
Last Update Date	:	06/07/2010

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