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General NPI Number Information
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NPI Number | 1649456542
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Entity Type | Organization
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Legal Business Name | KIM E PERSHALL MD PA
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Dates
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Enumeration Date | 01/10/2008
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Last Update Date | 01/31/2011
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Provider Practice Location Address
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Address Line | 3811 24TH STREET
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City | LUBBOCK
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State | TX
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Zip | 79410-1813
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Country | US
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Telephone | 806-796-0202
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Fax | 806-796-0496
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Provider Business Mailing Address
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Address Line | 3811 24TH STREET
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City | LUBBOCK
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State | TX
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Zip | 79410-1813
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Country | US
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Telephone | 806-796-0202
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Fax | 806-796-0496
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Authorized Official
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Title or Position | PHYSICIAN OWNER
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Name | KIM E. PERSHALL
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Credential | MD
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Telephone | 806-796-0202
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | J3574
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License Number State | TX
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