Provider Demographics
NPI:1215901368
Name:ADOLPH, HOWARD KEN (MD)
Entity type:Individual
Prefix:
First Name:HOWARD
Middle Name:KEN
Last Name:ADOLPH
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:PO BOX 300087
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78703-0002
Mailing Address - Country:US
Mailing Address - Phone:512-407-8444
Mailing Address - Fax:512-407-8097
Practice Address - Street 1:2304 HANCOCK DR STE 4
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78756-2540
Practice Address - Country:US
Practice Address - Phone:512-407-8444
Practice Address - Fax:512-407-8097
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2008-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK-9205207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXK-9205OtherSTATE LICENSE
87168NOtherMEDICARE
87168NOtherBLUE CROSS
TXK-9205OtherSTATE LICENSE
P00051007Medicare PIN
8A6767Medicare PIN
TX87168NMedicare PIN
TX50074418Medicare PIN