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General NPI Number Information
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NPI Number | 1841814506
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Entity Type | Organization
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Legal Business Name | KEVIN B. WALDREP, M.D.,PLLC
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Dates
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Enumeration Date | 05/28/2020
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Last Update Date | 06/12/2020
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Provider Practice Location Address
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Address Line | 7777 FOREST LN STE B111
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City | DALLAS
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State | TX
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Zip | 75230-2539
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Country | US
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Telephone | 972-566-4204
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Fax |
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Provider Business Mailing Address
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Address Line | 7777 FOREST LN STE B111
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City | DALLAS
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State | TX
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Zip | 75230-2539
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Country | US
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Telephone | 972-566-4204
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Fax |
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Authorized Official
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Title or Position | CREDENTIAL/DIRECTOR
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Name | MR. FRANCISCO A RODRIGUEZ
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Credential |
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Telephone | 972-566-4204
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State |
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