Healthcare Provider Details

I. General information

NPI: 1689902918
Provider Name (Legal Business Name): JAMES EDWARD KENT DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/24/2009
Last Update Date: 09/23/2020
Certification Date: 09/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6603 OAK HILL BLVD.
TYLER TX
75703-3604
US

IV. Provider business mailing address

6603 OAK HILL BLVD.
TYLER TX
75703-3604
US

V. Phone/Fax

Practice location:
  • Phone: 903-939-3668
  • Fax: 903-939-0661
Mailing address:
  • Phone: 903-939-3668
  • Fax: 903-939-0661

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number1927
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: