Healthcare Provider Details

I. General information

NPI: 1376861906
Provider Name (Legal Business Name): KENNY NEWGENE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/06/2010
Last Update Date: 06/15/2021
Certification Date: 06/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8609 SOUTHWESTERN BLVD APT 623
DALLAS TX
75206-8237
US

IV. Provider business mailing address

8609 SOUTHWESTERN BLVD 623
DALLAS TX
75206-2675
US

V. Phone/Fax

Practice location:
  • Phone: 318-655-3328
  • Fax:
Mailing address:
  • Phone: 318-655-3328
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD.41383
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number28982
License Number StateOK
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberQ2690
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: