Provider Demographics
NPI:1588611024
Name:COMFORT, KEVIN PATRICK (MD)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:PATRICK
Last Name:COMFORT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8715 VILLAGE DR
Mailing Address - Street 2:SUITE 510
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78217-5405
Mailing Address - Country:US
Mailing Address - Phone:210-637-0000
Mailing Address - Fax:210-654-9840
Practice Address - Street 1:8715 VILLAGE DR
Practice Address - Street 2:SUITE 510
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78217-5405
Practice Address - Country:US
Practice Address - Phone:210-637-0000
Practice Address - Fax:210-654-9840
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-30
Last Update Date:2010-01-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXG2117207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXB21947Medicare UPIN
TX00JW57Medicare ID - Type Unspecified