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General NPI Number Information
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NPI Number | 1447790431
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Entity Type | Organization
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Legal Business Name | KOOLMD.COM
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Dates
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Enumeration Date | 02/24/2017
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Last Update Date | 02/24/2017
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Provider Practice Location Address
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Address Line | 4742 LOMAS SANTA FE ST
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City | LAS VEGAS
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State | NV
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Zip | 89147-6029
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Country | US
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Telephone | 185-595-6656
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 230610
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City | LAS VEGAS
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State | NV
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Zip | 89105-0610
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. KEVIN TEMPLAR
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Credential | M.D.
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Telephone | 808-783-3666
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2083X0100X
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Taxonomy Name | Occupational Medicine Physician
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License Number | 9947
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License Number State | NV
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