MEDICARE: DR. DAVID A KENT M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	M5609	ID

General Provider Information

NPI Number	:	1215965199
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID A KENT M.D.

Provider Business Mailing Address
First Line	:	2375 S COBALT POINT WAY STE 102
Second Line	:
City	:	MERIDIAN
State	:	ID
Zip	:	83642-8029
Country	:	US
Telephone Number	:	208-863-0860
Fax Number	:	208-954-5595

Provider Business Practice Location Address
First Line	:	5561 N GLENWOOD ST STE B
Second Line	:
City	:	GARDEN CITY
State	:	ID
Zip	:	83714-1336
Country	:	US
Telephone Number	:	208-863-0860
Fax Number	:	208-954-5595

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/29/2006
Last Update Date	:	02/07/2024

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