Provider Demographics
NPI:1013359678
Name:KILGORE, BASSETT B (MD)
Entity Type:Individual
Prefix:DR
First Name:BASSETT
Middle Name:B
Last Name:KILGORE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2721 ROSEDALE AVE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75205-1528
Mailing Address - Country:US
Mailing Address - Phone:214-521-0408
Mailing Address - Fax:
Practice Address - Street 1:2721 ROSEDALE AVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75205-1528
Practice Address - Country:US
Practice Address - Phone:214-521-0408
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-24
Last Update Date:2013-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXC37302085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology