Provider Demographics
NPI:1598864290
Name:KENNETH S BAYLES DO PA
Entity Type:Organization
Organization Name:KENNETH S BAYLES DO PA
Other - Org Name:CENTER FOR FRACTURE TREATMENT & ORTHOPEDIC SURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ORTHOPEDIC SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:S
Authorized Official - Last Name:BAYLES
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:214-331-6444
Mailing Address - Street 1:PO BOX 223683
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75222-3683
Mailing Address - Country:US
Mailing Address - Phone:214-331-6444
Mailing Address - Fax:214-330-5765
Practice Address - Street 1:7777 FOREST LN
Practice Address - Street 2:SUITE C737
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-2505
Practice Address - Country:US
Practice Address - Phone:214-331-6444
Practice Address - Fax:214-330-5765
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXTEXASF2546207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX035210601Medicaid
TX035210601Medicaid
TXD97194Medicare UPIN
TXD97194Medicare ID - Type Unspecified