Provider Demographics
NPI:1689902918
Name:KENT, JAMES EDWARD (DPM)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:EDWARD
Last Name:KENT
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6603 OAK HILL BLVD.
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75703-3604
Mailing Address - Country:US
Mailing Address - Phone:903-939-3668
Mailing Address - Fax:903-939-0661
Practice Address - Street 1:6603 OAK HILL BLVD.
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75703-3604
Practice Address - Country:US
Practice Address - Phone:903-939-3668
Practice Address - Fax:903-939-0661
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-24
Last Update Date:2020-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1927213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8CV514OtherBCBS
TX8CV514OtherBCBS
TXTXB130381Medicare PIN