Individual
DR. KIM E PERSHALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
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
174400000X
Specialist
86103
NM
174400000X
Specialist
J3574
TX
207Y00000X
Otolaryngology Physician
Primary
J3574
TX
207YS0123X
Facial Plastic Surgery Physician
J3574
TX
207YX0602X
Otolaryngic Allergy Physician
J3574
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
034333701
—
TX
01
—
040007969
RAILROAD MEDICARE
TX
01
—
121351100
FIRSTCARE
TX
01
—
148127701
MEDICAID GROUP
TX
05
—
37234
—
NM
01
—
8F21125
MEDICARE PTAN
TX
01
—
8P8420
BCBS TX
TX
Enumeration date
06/22/2005
Last updated
01/31/2011
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