Individual
MR. HENRY SLOAN KINNEBREW IV
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1010 W 40TH ST, AUSTIN, TX 78756-4010
(512) 459-8753
Mailing address
1010 W 40TH ST, AUSTIN, TX 78756-4010
(512) 459-8753
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
—
—
Other
Enumeration date
09/10/2014
Last updated
09/10/2014
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