Provider Demographics
NPI:1417456138
Name:HUNTSMAN, KEVIN (DPM)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:
Last Name:HUNTSMAN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3900 JOE RAMSEY BLVD E BLDG 5
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75401-7727
Mailing Address - Country:US
Mailing Address - Phone:903-455-2383
Mailing Address - Fax:
Practice Address - Street 1:3900 JOE RAMSEY BLVD E BLDG 5
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:TX
Practice Address - Zip Code:75401-7727
Practice Address - Country:US
Practice Address - Phone:903-455-2383
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-08
Last Update Date:2020-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3039213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist