Provider Demographics
NPI:1487627493
Name:HARBOURNE, KEVIN S (MD)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:S
Last Name:HARBOURNE
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 1:2807 DANIEL MCCALL DR
Mailing Address - Street 2:APT. 314
Mailing Address - City:LUFKIN
Mailing Address - State:TX
Mailing Address - Zip Code:75904-7150
Mailing Address - Country:US
Mailing Address - Phone:956-466-5331
Mailing Address - Fax:
Practice Address - Street 1:500 W 4TH ST
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79761-5001
Practice Address - Country:US
Practice Address - Phone:432-640-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2022-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101228721207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8BG465OtherBCBS
VA010193320Medicaid
VA010193320Medicaid
TX8BG465OtherBCBS
008226W53Medicare ID - Type Unspecified