Healthcare Provider Details

I. General information

NPI: 1215971189
Provider Name (Legal Business Name): WILLIAM BLAKE KUTSCHE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 01/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2323 TEXAS ST
PECOS TX
79772-7338
US

IV. Provider business mailing address

2323 TEXAS ST
PECOS TX
79772-7338
US

V. Phone/Fax

Practice location:
  • Phone: 432-447-3551
  • Fax: 432-447-5434
Mailing address:
  • Phone: 432-447-3551
  • Fax: 432-447-5434

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number4301062066
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number4301062066
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number4301062066
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: