Provider Demographics
NPI:1568535995
Name:ALBERS, KENNETH OTTO (MD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:OTTO
Last Name:ALBERS
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 1:1035 IVY WALL DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77079-5037
Mailing Address - Country:US
Mailing Address - Phone:281-493-1645
Mailing Address - Fax:281-589-1465
Practice Address - Street 1:909 DAIRY ASHFORD ST
Practice Address - Street 2:SUITE 216
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77079-5309
Practice Address - Country:US
Practice Address - Phone:281-493-3681
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD4904207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8G4740OtherB.C.-B.S. PROVIDER NO.
TX01290024OtherMEDCARE RAILRD PROVIDER
TX01290024OtherMEDCARE RAILRD PROVIDER
TXB20835Medicare UPIN