Individual
KENNETH G COMBS
Active
Individual
KENNETH G COMBS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
01042412A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000109178
BCBS PIN
IN
01
—
000000504772
BCBS - LPI
IN
05
—
100340860
—
IN
01
—
P00386083
RR MEDICARE
IN
Enumeration date
05/31/2005
Last updated
12/10/2015
Update your record
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