=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598707853
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | WILLIAM SHANE KYLE M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/12/2006
-----------------------------------------------------
Last Update Date | 09/16/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10561 JEFFREYS ST SUITE 100
-----------------------------------------------------
City | HENDERSON
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89052-4266
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-478-5620
-----------------------------------------------------
Fax | 702-478-5093
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 629
-----------------------------------------------------
City | ALTOONA
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 50009-0629
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 515-645-9911
-----------------------------------------------------
Fax | 515-967-5581
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 10972
-----------------------------------------------------
License Number State | NV
-----------------------------------------------------