Individual
KYLE BARRON VINCENT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1947 FOUNDERS CIRCLE, WICHITA, KS 67206-0000
(316) 613-4707
(316) 613-4608
Mailing address
PO BOX 8035, WICHITA, KS 67208-0035
(316) 689-9135
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
04-34936
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
003719104
MEDICARE
—
05
—
200740030A
—
KS
Enumeration date
09/18/2008
Last updated
08/06/2015
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