Provider Demographics
NPI:1417045303
Name:SCARBOROUGH, KYLE LEE (MD)
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:LEE
Last Name:SCARBOROUGH
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 1:603 S CONROE MEDICAL DR STE 110
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77304-5395
Mailing Address - Country:US
Mailing Address - Phone:936-760-9900
Mailing Address - Fax:936-760-9926
Practice Address - Street 1:603 S. CONROE MEDICAL CENTER BLVD
Practice Address - Street 2:STE 110
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304
Practice Address - Country:US
Practice Address - Phone:936-760-9900
Practice Address - Fax:936-760-9926
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2023-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH8380207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX118743702Medicaid
TX86M973Medicare PIN
TX342933YZRJMedicare PIN
TX342933Medicare PIN
GA80046750Medicare PIN
TXE97722Medicare UPIN
TX342936YZRJMedicare PIN