Provider Demographics
NPI:1780212829
Name:KENDALL R ROEHL MD PLLC
Entity Type:Organization
Organization Name:KENDALL R ROEHL MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:KENDALL
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:ROEHL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:409-766-0936
Mailing Address - Street 1:419 PRAIRIE VW
Mailing Address - Street 2:
Mailing Address - City:DICKINSON
Mailing Address - State:TX
Mailing Address - Zip Code:77539-8321
Mailing Address - Country:US
Mailing Address - Phone:409-766-0936
Mailing Address - Fax:
Practice Address - Street 1:450 W MEDICAL CENTER BLVD STE 202
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598-4229
Practice Address - Country:US
Practice Address - Phone:409-766-0936
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-01
Last Update Date:2020-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty