Healthcare Provider Details

I. General information

NPI: 1700048964
Provider Name (Legal Business Name): JONATHAN DAVID KAYE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2008
Last Update Date: 05/10/2021
Certification Date: 05/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 8TH AVE FL 6
FORT WORTH TX
76104-2515
US

IV. Provider business mailing address

PO BOX 733784
DALLAS TX
75373-3784
US

V. Phone/Fax

Practice location:
  • Phone: 682-303-0376
  • Fax: 682-303-0377
Mailing address:
  • Phone: 682-885-1855
  • Fax: 682-885-1396

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2088P0231X
TaxonomyPediatric Urology Physician
License NumberN5149
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: