Individual
MR. KEVIN JOSEPH GIACONTIERE
Active
Individual
MR. KEVIN JOSEPH GIACONTIERE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
PA01948
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0040EE
BLUE CROSS BLUE SHIELD
TX
01
—
88N360
BLUE CROSS BLUE SHIELD
TX
01
—
970030195
MEDICARE RAILROAD
TX
01
—
CK7292
MEDICARE RAILROAD
TX
Enumeration date
06/20/2005
Last updated
05/26/2016
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