Healthcare Provider Details

I. General information

NPI: 1497745426
Provider Name (Legal Business Name): KYLE DOUGLAS JAMES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2005
Last Update Date: 09/23/2020
Certification Date: 09/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 HEWITT DR
WACO TX
76712-8486
US

IV. Provider business mailing address

PO BOX 848476
DALLAS TX
75284-8476
US

V. Phone/Fax

Practice location:
  • Phone: 903-579-2700
  • Fax:
Mailing address:
  • Phone: 254-202-4655
  • Fax: 254-202-4697

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberH8152
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: