Healthcare Provider Details

I. General information

NPI: 1174524441
Provider Name (Legal Business Name): KEVIN EDWARD BRIGHT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2005
Last Update Date: 08/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 MEDICAL CTR
EL PASO TX
79902-5002
US

IV. Provider business mailing address

5959 GATEWAY BLVD W STE120
EL PASO TX
79925-3331
US

V. Phone/Fax

Practice location:
  • Phone: 915-544-1350
  • Fax: 915-544-6740
Mailing address:
  • Phone: 915-779-1716
  • Fax: 915-771-6558

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberK7250
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: