Provider Demographics
NPI:1659313328
Name:DORITY, KENNETH RONALD (DO)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:RONALD
Last Name:DORITY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8414 FLOWER MEADOW DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75243-7424
Mailing Address - Country:US
Mailing Address - Phone:214-349-7440
Mailing Address - Fax:214-905-5015
Practice Address - Street 1:2912 KRAFT ST STE 30
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76010-5410
Practice Address - Country:US
Practice Address - Phone:402-885-0365
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK0722207QA0401X, 2083P0011X, 2083X0100X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
No2083P0011XAllopathic & Osteopathic PhysiciansPreventive MedicineUndersea and Hyperbaric Medicine
No2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX146888602Medicaid
TX8R6745OtherBLUE CROSS BLUE SHIELD
TXG33870Medicare UPIN
TX146888602Medicaid