Provider Demographics
NPI:1073585428
Name:RASMUSSEN, KENT R (MD)
Entity Type:Individual
Prefix:
First Name:KENT
Middle Name:R
Last Name:RASMUSSEN
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:PO BOX 120069
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76012
Mailing Address - Country:US
Mailing Address - Phone:817-274-1999
Mailing Address - Fax:817-274-4671
Practice Address - Street 1:950 N DAVIS
Practice Address - Street 2:SUITE 2
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76012
Practice Address - Country:US
Practice Address - Phone:817-277-4723
Practice Address - Fax:817-277-7407
Is Sole Proprietor?:No
Enumeration Date:2006-02-01
Last Update Date:2011-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF3300207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX125282701Medicaid
83395KMedicare ID - Type Unspecified
TX125282701Medicaid