Provider Demographics
NPI:1700629649
Name:JOHN, KEVIN ROBBIE
Entity type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:ROBBIE
Last Name:JOHN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 UNIVERSITY BLVD- JSA9 128
Mailing Address - Street 2:
Mailing Address - City:GALVESTON
Mailing Address - State:TX
Mailing Address - Zip Code:77555-0539
Mailing Address - Country:US
Mailing Address - Phone:409-772-8031
Mailing Address - Fax:409-747-0011
Practice Address - Street 1:301 UNIVERSITY BLVD- JSA9 128
Practice Address - Street 2:
Practice Address - City:GALVESTON
Practice Address - State:TX
Practice Address - Zip Code:77555-0539
Practice Address - Country:US
Practice Address - Phone:409-772-8031
Practice Address - Fax:409-747-0011
Is Sole Proprietor?:No
Enumeration Date:2024-06-18
Last Update Date:2024-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP100899392084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology