Provider Demographics
NPI:1417061607
Name:TAUB, KENT ALAN (MD)
Entity Type:Individual
Prefix:
First Name:KENT
Middle Name:ALAN
Last Name:TAUB
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 1:613 FAIRWAY VIEW TER
Mailing Address - Street 2:
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-9550
Mailing Address - Country:US
Mailing Address - Phone:214-649-1444
Mailing Address - Fax:
Practice Address - Street 1:613 FAIRWAY VIEW TER
Practice Address - Street 2:
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-9550
Practice Address - Country:US
Practice Address - Phone:214-649-1444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2010-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ6042207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP00759870OtherRAILROAD MEDICARE THRU HEB
TX138767225Medicaid
TX8AB544OtherBCBSTX
TX8L19087Medicare PIN
TX138767225Medicaid