Individual
KENNETH C. LAO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2401 S 31ST ST, TEMPLE, TX 76508-0001
(254) 724-3937
(254) 724-7791
Mailing address
PO BOX 844658, DALLAS, TX 75284-4658
(254) 724-2111
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
22968
OK
207W00000X
Ophthalmology Physician
63914
GA
207W00000X
Ophthalmology Physician
Primary
P3752
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
102I186286
MEDICARE PTAN
GA
Enumeration date
01/27/2006
Last updated
09/30/2020
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