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1477649754

NPI Code Detail

MEDICARE: KENNETH E DORSEY MD

MEDICARE: KENNETH E DORSEY MD

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	207NS0135X	Procedural Dermatology Physician	K1811	TX
2	207N00000X	Dermatology Physician	K1811	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1477649754
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENNETH E DORSEY MD

Provider Business Mailing Address
First Line	:	11511 SHADOW CREEK PKWY
Second Line	:
City	:	PEARLAND
State	:	TX
Zip	:	77584-7298
Country	:	US
Telephone Number	:	713-442-0000
Fax Number	:

Provider Business Practice Location Address
First Line	:	560 MEYERLAND PLAZA MALL
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77096-1615
Country	:	US
Telephone Number	:	713-442-1615
Fax Number	:

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

Provider Enumeration Date	:	10/05/2006
Last Update Date	:	06/07/2021

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Directions to “ KENNETH E DORSEY MD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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