Provider Demographics
NPI:1023051109
Name:KINCHELOE, ROBERT W (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:W
Last Name:KINCHELOE
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 1:8310 N CAPITAL OF TEXAS HWY
Mailing Address - Street 2:SUITE 350
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731-1011
Mailing Address - Country:US
Mailing Address - Phone:512-342-2382
Mailing Address - Fax:512-342-2878
Practice Address - Street 1:8310 N CAPITAL OF TEXAS HWY
Practice Address - Street 2:SUITE 350
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-1011
Practice Address - Country:US
Practice Address - Phone:512-342-2382
Practice Address - Fax:512-342-2878
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-14
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF9667207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXC17879Medicare UPIN
TX82G206Medicare ID - Type UnspecifiedINDIVIDUAL MEDICARE
TX00A80JMedicare ID - Type UnspecifiedGROUP MEDICARE