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General NPI Number Information
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NPI Number | 1982199519
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Entity Type | Individual
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Provider Name | KYLE MATTHEW GEORGE DO
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Gender | Male
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Dates
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Enumeration Date | 06/26/2018
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Last Update Date | 07/23/2024
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Provider Practice Location Address
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Address Line | 125 NEWMAN ST
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City | FAIRFIELD
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State | TX
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Zip | 75840-1419
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Country | US
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Telephone | 903-389-2121
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Fax |
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Provider Business Mailing Address
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Address Line | 1650 WINDMILL CT
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City | ALLEN
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State | TX
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Zip | 75002-7385
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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 | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 6656
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 6656
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License Number State | OK
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Taxonomy #3
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | T0214
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License Number State | TX
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