MEDICARE: DR. KENNETH RONALD DORITY D.O.

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	207QA0401X	Addiction Medicine (Family Medicine) Physician	K0722	TX
2	2083P0011X	Undersea and Hyperbaric Medicine (Preventive Medicine) Physician	K0722	TX
3	2083X0100X	Occupational Medicine Physician	K0722	TX
4	207Q00000X	Family Medicine Physician	K0722	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	8R6745	OTHER	TX	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1659313328
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KENNETH RONALD DORITY D.O.

Provider Business Mailing Address
First Line	:	8414 FLOWER MEADOW DR
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75243-7424
Country	:	US
Telephone Number	:	214-349-7440
Fax Number	:	214-905-5015

Provider Business Practice Location Address
First Line	:	2912 KRAFT ST STE 30
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76010-5410
Country	:	US
Telephone Number	:	402-885-0365
Fax Number	:

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

Provider Enumeration Date	:	06/10/2006
Last Update Date	:	08/25/2022

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Directions to “ DR. KENNETH RONALD DORITY D.O.” Practice Location

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