Healthcare Provider Details

I. General information

NPI: 1689964215
Provider Name (Legal Business Name): KYLE LAMAR GUMMELT D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/16/2011
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8222 DOUGLAS AVE STE 600
DALLAS TX
75225-5937
US

IV. Provider business mailing address

8222 DOUGLAS AVE STE 600
DALLAS TX
75225-5937
US

V. Phone/Fax

Practice location:
  • Phone: 972-993-5040
  • Fax: 972-993-5041
Mailing address:
  • Phone: 972-993-5040
  • Fax: 972-993-5041

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberP4653
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: