Provider Demographics
NPI:1538359948
Name:KUO, JEFF (MD)
Entity type:Individual
Prefix:
First Name:JEFF
Middle Name:
Last Name:KUO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:SHIH-CHIEH
Other - Middle Name:
Other - Last Name:KUO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:100 W 30TH AVE
Mailing Address - Street 2:SUITE 108
Mailing Address - City:PAMPA
Mailing Address - State:TX
Mailing Address - Zip Code:79065-2814
Mailing Address - Country:US
Mailing Address - Phone:806-663-5654
Mailing Address - Fax:806-663-5642
Practice Address - Street 1:100 W 30TH AVE
Practice Address - Street 2:SUITE 108
Practice Address - City:PAMPA
Practice Address - State:TX
Practice Address - Zip Code:79065-2814
Practice Address - Country:US
Practice Address - Phone:806-663-5654
Practice Address - Fax:806-663-5642
Is Sole Proprietor?:No
Enumeration Date:2007-07-31
Last Update Date:2013-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAGETP.LSU.PEDIATRIC208000000X
IN01064319A208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200878910Medicaid
IN000000545123OtherANTHEM, BCBS
IN151020 OOOMedicare PIN