Davis, Kent Matthew

Davis, Kent Matthew is an individual health care provider with primary practice located at 8288 S Broadway Ave , Tyler TX 75703. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Internal Medicine, Allopathic & Osteopathic Physicians / Geriatric Medicine. Allopathic & Osteopathic Physicians / Geriatric Medicine is his primary health care specialty. Davis, Kent Matthew can be contacted via phone (903) 606-7060.

Contact Information

Primary practice address
8288 S Broadway Ave Tyler TX 75703
Phone: (903) 606-7060
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Internal Medicine 207R00000X H5863 Texas
Allopathic & Osteopathic Physicians / Geriatric Medicine 207RG0300X H5863 Texas

Profile Details

NPI number 1548259179
LBN Legal business name Davis, Kent Matthew
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Oct 17th, 2005
Last updated Sep 11th, 2023 - about 3 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1548259179 NPPES
Texas Other P02095992 MEDICARE RAIL ROAD
Texas MEDICAID 106108703 MEDICARE RAIL ROAD
Texas Other 709790 MEDICARE RAIL ROAD

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