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General NPI Number Information
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NPI Number | 1700660628
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Entity Type | Organization
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Legal Business Name | KENNETH ARCHER MD PA
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Dates
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Enumeration Date | 08/22/2023
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Last Update Date | 08/22/2023
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Provider Practice Location Address
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Address Line | 1016 BOURLAND RD
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City | KELLER
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State | TX
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Zip | 76248-3925
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Country | US
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Telephone | 817-691-8711
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2077
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City | KELLER
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State | TX
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Zip | 76244-2077
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. KENNETH ARCHER
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Credential |
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Telephone | 817-691-8711
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QA0505X
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Taxonomy Name | Adult Medicine Physician
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License Number |
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License Number State |
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