Individual
KENNETH R CLOSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2722 OSLER BLVD, BRYAN, TX 77802-2517
(979) 776-8291
(979) 774-7871
Mailing address
2722 OSLER BLVD, BRYAN, TX 77802-2517
(979) 776-8291
(979) 774-7871
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
L3942
TX
2085R0202X
Diagnostic Radiology Physician
ME171890
FL
2085R0204X
Vascular & Interventional Radiology Physician
L3942
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
161640102
—
TX
Enumeration date
04/06/2006
Last updated
02/05/2025
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