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General NPI Number Information
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NPI Number | 1255623989
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Entity Type | Organization
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Legal Business Name | KRB ENTERPRISES
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Dates
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Enumeration Date | 05/13/2011
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Last Update Date | 05/13/2011
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Provider Practice Location Address
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Address Line | 11830 FM 1960 RD W
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City | HOUSTON
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State | TX
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Zip | 77065-3840
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Country | US
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Telephone | 832-814-3987
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Fax |
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Provider Business Mailing Address
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Address Line | 4321 KINGWOOD DR SUITE 143
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City | KINGWOOD
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State | TX
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Zip | 77339-3700
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Country | US
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Telephone | 832-814-3987
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Fax |
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Authorized Official
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Title or Position | C.E.O
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Name | MR. KEVIN RYAN BAKER
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Credential |
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Telephone | 832-814-3987
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | F1792
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | K8496
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License Number State | TX
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