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General NPI Number Information
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NPI Number | 1255360889
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Entity Type | Individual
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Provider Name | ROBERT SCOTT KINKADE M .D.
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Gender | Male
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Dates
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Enumeration Date | 07/03/2006
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 651 W MINGUS AVE SUITE 1D
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City | COTTONWOOD
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State | AZ
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Zip | 86326-4006
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Country | US
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Telephone | 928-649-1000
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Fax | 928-649-3929
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Provider Business Mailing Address
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Address Line | 651 W. MINGUS AVE, STE 1D
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City | COTTONWOOD
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State | AZ
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Zip | 86326
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Country | US
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Telephone | 928-649-1000
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Fax | 928-649-3929
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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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 26410
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License Number State | AZ
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