Provider Demographics
NPI:1518078229
Name:ISRAEL, KIM E (MD)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:E
Last Name:ISRAEL
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 1:7002 CAYMAN CT
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79124-1153
Mailing Address - Country:US
Mailing Address - Phone:806-584-8419
Mailing Address - Fax:
Practice Address - Street 1:AMARILLO VA HEALTHCARE SYSTEM
Practice Address - Street 2:6010 AMARILLO BLVD WEST
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106
Practice Address - Country:US
Practice Address - Phone:806-356-3705
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE6436207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8R5669OtherBCBS
B23710Medicare UPIN
TX8R5669OtherBCBS
TXP00186993Medicare ID - Type UnspecifiedRAILROAD MEDICARE