Provider Demographics
NPI:1447541693
Name:KINLOCH, RAMON LAROD (MD)
Entity type:Individual
Prefix:
First Name:RAMON
Middle Name:LAROD
Last Name:KINLOCH
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 733784
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75373-3784
Mailing Address - Country:US
Mailing Address - Phone:682-885-1855
Mailing Address - Fax:682-885-1396
Practice Address - Street 1:3200 RIVERFRONT DR
Practice Address - Street 2:SUITE 103
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76107-6570
Practice Address - Country:US
Practice Address - Phone:817-336-3800
Practice Address - Fax:817-335-9454
Is Sole Proprietor?:No
Enumeration Date:2011-04-22
Last Update Date:2021-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC173024390200000X, 390200000X
TXQ2916208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program