Healthcare Provider Details

I. General information

NPI: 1538359948
Provider Name (Legal Business Name): JEFF KUO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: SHIH-CHIEH KUO

II. Dates (important events)

Enumeration Date: 07/31/2007
Last Update Date: 08/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 W 30TH AVE SUITE 108
PAMPA TX
79065-2814
US

IV. Provider business mailing address

100 W 30TH AVE SUITE 108
PAMPA TX
79065-2814
US

V. Phone/Fax

Practice location:
  • Phone: 806-663-5654
  • Fax: 806-663-5642
Mailing address:
  • Phone: 806-663-5654
  • Fax: 806-663-5642

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberGETP.LSU.PEDIATRIC
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number01064319A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: