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General NPI Number Information
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NPI Number | 1841859519
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Entity Type | Individual
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Provider Name | KINDALL MARTIN DO
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Gender | Male
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Dates
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Enumeration Date | 06/06/2019
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Last Update Date | 06/06/2019
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Provider Practice Location Address
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Address Line | 1102 W 32ND ST
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City | JOPLIN
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State | MO
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Zip | 64804-3503
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Country | US
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Telephone | 870-688-8154
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Fax |
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Provider Business Mailing Address
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Address Line | 1031 MCINTOSH CIR
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City | JOPLIN
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State | MO
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Zip | 64804-3643
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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 |
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Name |
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Credential |
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Telephone |
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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 | PENDING
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License Number State | MO
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