MEDICARE: DR. KENT STUART AFTERGUT 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	207N00000X	Dermatology Physician	L1788	TX

General Provider Information

NPI Number	:	1922091016
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KENT STUART AFTERGUT MD

Provider Business Mailing Address
First Line	:	9900 N CENTRAL EXPY STE 500
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75231-0928
Country	:	US
Telephone Number	:	214-987-3376
Fax Number	:	469-532-0273

Provider Business Practice Location Address
First Line	:	610 UPTOWN BLVD STE 610
Second Line	:
City	:	CEDAR HILL
State	:	TX
Zip	:	75104-3528
Country	:	US
Telephone Number	:	972-283-8979
Fax Number	:	469-532-0273

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

Provider Enumeration Date	:	08/24/2005
Last Update Date	:	08/01/2025

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