Provider Demographics
NPI:1649384116
Name:GODSEY, KENNETH BASIL (MD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:BASIL
Last Name:GODSEY
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:4708 ALLIANCE BLVD STE 300
Mailing Address - Street 2:BAYLOR MEDICAL PLAZA 1
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-5339
Mailing Address - Country:US
Mailing Address - Phone:972-758-6000
Mailing Address - Fax:972-758-6001
Practice Address - Street 1:4708 ALLIANCE BLVD STE 300
Practice Address - Street 2:BAYLOR MEDICAL PLAZA 1
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-5339
Practice Address - Country:US
Practice Address - Phone:972-758-6000
Practice Address - Fax:972-758-6001
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2022-12-20
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Provider Licenses
StateLicense IDTaxonomies
TXH1774207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0980039-03Medicaid
TX010054856OtherRR MEDICARE
TX0980039-03Medicaid
TX8B9905Medicare UPIN