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General NPI Number Information
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NPI Number | 1144333857
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Entity Type | Individual
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Provider Name | GEORGE MICHAEL KENT M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/16/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2910 SHED RD
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City | BOSSIER CITY
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State | LA
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Zip | 71111-3154
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Country | US
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Telephone | 318-742-5124
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Fax | 318-746-6080
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Provider Business Mailing Address
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Address Line | 173 CAPT. H. M. SHREVE BOULEVARD
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City | SHREVEPORT
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State | LA
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Zip | 71115-2961
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Country | US
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Telephone | 318-795-9494
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 11482
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License Number State | LA
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