Provider Demographics
NPI:1801274477
Name:GOLDEN, KEVIN BERT (MD)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:BERT
Last Name:GOLDEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 162464
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76161-2464
Mailing Address - Country:US
Mailing Address - Phone:871-810-9810
Mailing Address - Fax:871-810-9815
Practice Address - Street 1:1025 COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-3013
Practice Address - Country:US
Practice Address - Phone:817-810-9810
Practice Address - Fax:817-810-9815
Is Sole Proprietor?:No
Enumeration Date:2015-05-14
Last Update Date:2023-04-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
390200000X
TXS4767207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program