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Organization
KIM E PERSHALL MD PA
Active
Organization
KIM E PERSHALL MD PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KIM E. PERSHALL MD (PHYSICIAN OWNER)
(806) 796-0202
Entity
Organization
Contact information
Practice address
3811 24TH STREET, LUBBOCK, TX 79410-1813
(806) 796-0202
(806) 796-0496
Mailing address
3811 24TH STREET, LUBBOCK, TX 79410-1813
(806) 796-0202
(806) 796-0496
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
J3574
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
034333701
—
TX
01
—
040007969
RR MEDICARE
TX
01
—
121351100
FIRSTCARE
TX
01
—
148127701
MEDICAID GROUP
TX
05
—
37234
—
NM
01
—
8P8420
BCBS
TX
Enumeration date
01/10/2008
Last updated
01/31/2011
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