Healthcare Provider Details

I. General information

NPI: 1184612905
Provider Name (Legal Business Name): RONALD S KLINE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/06/2005
Last Update Date: 05/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 W MAYFIELD RD SUITE 416
ARLINGTON TX
76014-2083
US

IV. Provider business mailing address

515 W MAYFIELD RD SUITE 416
ARLINGTON TX
76014-2083
US

V. Phone/Fax

Practice location:
  • Phone: 817-417-8748
  • Fax: 817-419-8788
Mailing address:
  • Phone: 817-417-8748
  • Fax: 817-419-8788

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License NumberE1000
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: