Provider Demographics
NPI:1922091016
Name:AFTERGUT, KENT STUART (MD)
Entity Type:Individual
Prefix:DR
First Name:KENT
Middle Name:STUART
Last Name:AFTERGUT
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 1:610 UPTOWN BLVD STE 610
Mailing Address - Street 2:
Mailing Address - City:CEDAR HILL
Mailing Address - State:TX
Mailing Address - Zip Code:75104-3528
Mailing Address - Country:US
Mailing Address - Phone:972-283-8979
Mailing Address - Fax:972-283-8988
Practice Address - Street 1:610 UPTOWN BLVD STE 610
Practice Address - Street 2:
Practice Address - City:CEDAR HILL
Practice Address - State:TX
Practice Address - Zip Code:75104-3528
Practice Address - Country:US
Practice Address - Phone:972-283-8979
Practice Address - Fax:972-283-8988
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-24
Last Update Date:2010-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL1788207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX164468401Medicaid
8A7769Medicare ID - Type Unspecified
H86484Medicare UPIN