Provider Demographics
NPI:1902015043
Name:KEDORA, JOHN C (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:C
Last Name:KEDORA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:621 N HALL ST
Mailing Address - Street 2:STE 100
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75226-1339
Mailing Address - Country:US
Mailing Address - Phone:214-821-9600
Mailing Address - Fax:214-823-5449
Practice Address - Street 1:621 N HALL ST
Practice Address - Street 2:STE 100
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75226-1339
Practice Address - Country:US
Practice Address - Phone:214-821-9600
Practice Address - Fax:214-823-5449
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2022-09-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXM6692174400000X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXM6692OtherSTATE LICENSE