Healthcare Provider Details

I. General information

NPI: 1528262102
Provider Name (Legal Business Name): KENDALL RENEE ROEHL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2007
Last Update Date: 03/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26 PROFESSIONAL PARK DR
WEBSTER TX
77598-4127
US

IV. Provider business mailing address

26 PROFESSIONAL PARK DR
WEBSTER TX
77598-4127
US

V. Phone/Fax

Practice location:
  • Phone: 713-609-9335
  • Fax:
Mailing address:
  • Phone: 713-609-9335
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License NumberBP2-0019769
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License NumberM8291
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: