Provider Demographics
NPI:1578673265
Name:KATZ, KENT DOUGLAS (MD)
Entity Type:Individual
Prefix:
First Name:KENT
Middle Name:DOUGLAS
Last Name:KATZ
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 1:1441 WILKINS CIRCLE
Mailing Address - Street 2:GASTROENTEROLOGY ASSOCIATES PC
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82601
Mailing Address - Country:US
Mailing Address - Phone:307-265-1792
Mailing Address - Fax:207-237-8106
Practice Address - Street 1:1441 WILKINS CIRCLE
Practice Address - Street 2:GASTROENTEROLOGY ASSOCIATES PC
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82601
Practice Address - Country:US
Practice Address - Phone:307-265-1792
Practice Address - Fax:207-237-8106
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY6329A207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0058812Medicaid
308319OtherBC
MT0058812Medicaid
WY308319Medicare ID - Type Unspecified