Provider Demographics
NPI:1336144351
Name:LEMMON, KENNETH P (MD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:P
Last Name:LEMMON
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 1:117 MEDICAL CIRCLE
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:TX
Mailing Address - Zip Code:75751
Mailing Address - Country:US
Mailing Address - Phone:903-676-3200
Mailing Address - Fax:903-676-3277
Practice Address - Street 1:117 MEDICAL CIRCLE
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:TX
Practice Address - Zip Code:75751
Practice Address - Country:US
Practice Address - Phone:903-676-3200
Practice Address - Fax:903-676-3277
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2009-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE4479207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX80F788OtherBCBS
TX114560903Medicaid
TX80F788OtherBCBS
TX80F788Medicare ID - Type UnspecifiedMEDICARE