Healthcare Provider Details

I. General information

NPI: 1285637876
Provider Name (Legal Business Name): PAUL KINBERG D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2005
Last Update Date: 02/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1151 N BUCKNER BLVD STE 304
DALLAS TX
75218-3405
US

IV. Provider business mailing address

1151 N BUCKNER BLVD STE 304
DALLAS TX
75218-3405
US

V. Phone/Fax

Practice location:
  • Phone: 214-826-0111
  • Fax: 877-631-1566
Mailing address:
  • Phone: 214-826-0111
  • Fax: 877-631-1566

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number503
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: