Provider Demographics
NPI:1386656882
Name:KENNEDY, PAUL A III (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:A
Last Name:KENNEDY
Suffix:III
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 1:1101 PAW PRINT
Mailing Address - Street 2:
Mailing Address - City:LEANDER
Mailing Address - State:TX
Mailing Address - Zip Code:78641-3649
Mailing Address - Country:US
Mailing Address - Phone:512-800-3212
Mailing Address - Fax:512-986-7311
Practice Address - Street 1:4916 OVERTON PLZ
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76109-4415
Practice Address - Country:US
Practice Address - Phone:817-334-0530
Practice Address - Fax:817-877-0350
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2012-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI7932207L00000X
TXH6336207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI07349001Medicaid
HI95513OtherHMSA
F35919Medicare UPIN
HI0000BDTMWMedicare ID - Type Unspecified
HI95513OtherHMSA