Basic Information
| Provider Information | |||||||||
| NPI: | 1447450499 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KILGORE | ||||||||
| FirstName: | JOSHUA | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 911230 | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 753911230 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9729978000 | ||||||||
| FaxNumber: | 9722340813 | ||||||||
| Practice Location | |||||||||
| Address1: | 1000 S COULTER ST STE 100 | ||||||||
| Address2: | |||||||||
| City: | AMARILLO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 79106 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8063588654 | ||||||||
| FaxNumber: | 8063568687 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/18/2007 | ||||||||
| LastUpdateDate: | 09/13/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207VX0201X | Q0083 | TX | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Gynecologic Oncology |
ID Information
| ID | Type | State | Issuer | Description | 338187302 | 05 | TX | MEDICAID | 338187305 | 05 | TX | MEDICAID | 338187303 | 05 | TX | MEDICAID | 338187301 | 05 | TX | MEDICAID | 8EK638 | 01 | TX | BLUE CROSS BLUE SHIELD | OTHER | 8FX471 | 01 | TX | BLUE CROSS BLUE SHIELD | OTHER |