Individual
KENT MATTHEW DAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
8288 S BROADWAY AVE, TYLER, TX 75703
(903) 606-7060
Mailing address
PO BOX 846098, DALLAS, TX 75284-6098
(903) 324-6400
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
H5863
TX
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
Primary
H5863
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
106108703
—
TX
01
—
709790
MEDICARE
TX
01
—
P02095992
MEDICARE RAIL ROAD
TX
Enumeration date
10/17/2005
Last updated
09/11/2023
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