Provider Demographics
NPI:1568429975
Name:DOODY, KEVIN JOHN (MD)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:JOHN
Last Name:DOODY
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 1:1701 PARK PLACE AVE
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76022-6033
Mailing Address - Country:US
Mailing Address - Phone:817-540-1157
Mailing Address - Fax:817-267-0522
Practice Address - Street 1:1701 PARK PLACE AVE
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76022-6033
Practice Address - Country:US
Practice Address - Phone:817-540-1157
Practice Address - Fax:817-267-0522
Is Sole Proprietor?:No
Enumeration Date:2006-04-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG3303207VE0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive Endocrinology
Provider Identifiers
StateIdentifier IDID TypeIssuer
D95151Medicare UPIN
TX8D9853Medicare ID - Type Unspecified