=====================================================
General NPI Number Information
=====================================================
NPI Number | 1366408924
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DOUGLAS E KYLE JR. MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/24/2006
-----------------------------------------------------
Last Update Date | 06/05/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2451 S FM 51 STE 300
-----------------------------------------------------
City | DECATUR
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76234-3861
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 940-627-4216
-----------------------------------------------------
Fax | 940-627-4709
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2451 S FM 51 STE 300
-----------------------------------------------------
City | DECATUR
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76234-3861
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 940-627-4216
-----------------------------------------------------
Fax | 940-627-4709
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207V00000X
-----------------------------------------------------
Taxonomy Name | Obstetrics & Gynecology Physician
-----------------------------------------------------
License Number | H6361
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------