Provider Demographics
NPI:1861474249
Name:WORLEY, KYLE E (MD)
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:E
Last Name:WORLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4535 FORD ST
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77706-7461
Mailing Address - Country:US
Mailing Address - Phone:409-866-3513
Mailing Address - Fax:
Practice Address - Street 1:3127 COLLEGE ST
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77701-4609
Practice Address - Country:US
Practice Address - Phone:409-899-1433
Practice Address - Fax:409-981-9086
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ6821208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXG33220Medicare UPIN