Provider Demographics
NPI:1871679654
Name:PAGE, JOHN KEVIN (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:KEVIN
Last Name:PAGE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9330 LBJ FWY STE 800
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75243-4310
Mailing Address - Country:US
Mailing Address - Phone:972-792-5700
Mailing Address - Fax:
Practice Address - Street 1:1631 LANCASTER DR STE 330
Practice Address - Street 2:
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-3585
Practice Address - Country:US
Practice Address - Phone:817-953-3420
Practice Address - Fax:817-953-3418
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK2255207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0051GLMedicare PIN
G42342Medicare UPIN