Provider Demographics
NPI:1700260130
Name:KENWORTHY, JOHN ELIASON (DO)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:ELIASON
Last Name:KENWORTHY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5016 S US HIGHWAY 75
Mailing Address - Street 2:ATTN: RESIDENCY PROGRAM
Mailing Address - City:DENISON
Mailing Address - State:TX
Mailing Address - Zip Code:75020-4584
Mailing Address - Country:US
Mailing Address - Phone:714-414-6339
Mailing Address - Fax:903-416-6195
Practice Address - Street 1:1906 W US HIGHWAY 82
Practice Address - Street 2:
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75092
Practice Address - Country:US
Practice Address - Phone:903-892-8398
Practice Address - Fax:903-892-6665
Is Sole Proprietor?:No
Enumeration Date:2015-07-15
Last Update Date:2018-08-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXBP10054762 594752207Q00000X
TXR1057207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine