Provider Demographics
NPI:1013993203
Name:KASDEN, SCOTT EDWARD (MD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:EDWARD
Last Name:KASDEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:2813 W SOUTHLAKE BLVD. STE 130
Mailing Address - Street 2:SUITE130
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-6829
Mailing Address - Country:US
Mailing Address - Phone:817-416-9980
Mailing Address - Fax:817-337-7379
Practice Address - Street 1:2813 W SOUTHLAKE BLVD SUITE 130
Practice Address - Street 2:SUITE 130
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-6829
Practice Address - Country:US
Practice Address - Phone:817-416-9980
Practice Address - Fax:817-337-7379
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-19
Last Update Date:2016-04-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXJ3827208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery