Provider Demographics
NPI:1265638035
Name:KINZLER, DAMIEN W (DO)
Entity Type:Individual
Prefix:DR
First Name:DAMIEN
Middle Name:W
Last Name:KINZLER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26500 AGOURA ROAD
Mailing Address - Street 2:STE 102-261
Mailing Address - City:AUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:78703-5460
Mailing Address - Country:US
Mailing Address - Phone:817-291-1499
Mailing Address - Fax:
Practice Address - Street 1:2901 4TH ST
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75605-5128
Practice Address - Country:US
Practice Address - Phone:903-758-1818
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-26
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A18326207P00000X
PAOT012268207P00000X
NVDO3481207P00000X
TXN9580207P00000X
ORDO212431207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX285049702Medicaid
TX285049703Medicaid
TXP01059772OtherRAILROAD MEDICARE
TX285049702Medicaid
TXTXB150604Medicare PIN