Provider Demographics
NPI:1942288576
Name:BAYLES, KENNETH S (DO)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:S
Last Name:BAYLES
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2909 S HAMPTON RD
Mailing Address - Street 2:A-101
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75224
Mailing Address - Country:US
Mailing Address - Phone:214-331-6444
Mailing Address - Fax:214-330-5765
Practice Address - Street 1:2909 S HAMPTON RD
Practice Address - Street 2:A-101
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75224
Practice Address - Country:US
Practice Address - Phone:214-331-6444
Practice Address - Fax:214-330-5765
Is Sole Proprietor?:No
Enumeration Date:2006-01-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF2546207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXD97194Medicare ID - Type Unspecified
D97194Medicare UPIN