Provider Demographics
NPI:1083654123
Name:ARCHER, KENNETH DEAN (MD)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:DEAN
Last Name:ARCHER
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 1:2000 S FM 51
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:TX
Mailing Address - Zip Code:76234-3702
Mailing Address - Country:US
Mailing Address - Phone:817-479-3818
Mailing Address - Fax:817-479-3884
Practice Address - Street 1:8479 DAVIS BLVD STE 300
Practice Address - Street 2:
Practice Address - City:NORTH RICHLAND HILLS
Practice Address - State:TX
Practice Address - Zip Code:76182-8604
Practice Address - Country:US
Practice Address - Phone:817-479-3818
Practice Address - Fax:817-479-3884
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2021-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL7965207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXPENDINGOtherBCBS
TXPENDINGMedicaid
TX184653705Medicaid
TX184653706Medicaid
TXTXB146159Medicare PIN
TX184653705Medicaid