Provider Demographics
NPI:1245201565
Name:KINN, ERIC NORMAN (MD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:NORMAN
Last Name:KINN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:182 BARTLETT DR
Mailing Address - Street 2:
Mailing Address - City:PITTSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27312-7516
Mailing Address - Country:US
Mailing Address - Phone:940-230-4379
Mailing Address - Fax:
Practice Address - Street 1:529 N GALLOWAY AVE
Practice Address - Street 2:SUITE 16
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75149-3420
Practice Address - Country:US
Practice Address - Phone:972-216-4411
Practice Address - Fax:972-216-7346
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA658782085R0202X
TXM67072085R0202X
IL036-117112085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH98699Medicare UPIN