Provider Demographics
NPI:1750515102
Name:PERMIAN OCCUPATIONAL MEDICINE
Entity type:Organization
Organization Name:PERMIAN OCCUPATIONAL MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:H
Authorized Official - Last Name:KINZIE
Authorized Official - Suffix:IV
Authorized Official - Credentials:MD
Authorized Official - Phone:432-684-7780
Mailing Address - Street 1:301 DODSON ST
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79701-6334
Mailing Address - Country:US
Mailing Address - Phone:432-684-7780
Mailing Address - Fax:432-684-7782
Practice Address - Street 1:301 DODSON ST
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79701-6334
Practice Address - Country:US
Practice Address - Phone:432-684-7780
Practice Address - Fax:432-684-7782
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-13
Last Update Date:2009-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG8562207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty