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General NPI Number Information
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NPI Number | 1174183123
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Entity Type | Individual
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Provider Name | KIMBERLY LAUREN PROCK MD
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Gender | Female
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Dates
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Enumeration Date | 06/20/2019
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Last Update Date | 06/20/2019
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Provider Practice Location Address
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Address Line | 5200 HARRY HINES BLVD
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City | DALLAS
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State | TX
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Zip | 75235-7709
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Country | US
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Telephone | 956-572-4915
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Fax |
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Provider Business Mailing Address
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Address Line | 2828 LEMMON AVE APT 3159
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City | DALLAS
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State | TX
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Zip | 75204-3754
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Country | US
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Telephone | 956-572-4915
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number | BP10066760
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License Number State | TX
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