Individual
DR. KEVIN M SUPPLE
Active
Individual
DR. KEVIN M SUPPLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
36604
NC
207X00000X
Orthopaedic Surgery Physician
36604
NC
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
Primary
36604
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8981007
—
NC
Enumeration date
08/10/2005
Last updated
02/24/2022
Update your record
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