Healthcare Provider Details

I. General information

NPI: 1730362807
Provider Name (Legal Business Name): DUSTIN GENE KIKER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2007
Last Update Date: 01/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 E WHITESTONE BLVD STE 201
CEDAR PARK TX
78613-5028
US

IV. Provider business mailing address

PO BOX 35629
DALLAS TX
75235-0629
US

V. Phone/Fax

Practice location:
  • Phone: 512-341-0900
  • Fax: 817-341-2895
Mailing address:
  • Phone: 214-424-2200
  • Fax: 214-231-2159

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberN2599
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: