Provider Demographics
NPI:1194705301
Name:LAYTON, KENNITH F (MD)
Entity type:Individual
Prefix:
First Name:KENNITH
Middle Name:F
Last Name:LAYTON
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3500 GASTON AVE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75246-2017
Mailing Address - Country:US
Mailing Address - Phone:214-826-8822
Mailing Address - Fax:214-826-9792
Practice Address - Street 1:3500 GASTON AVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75246-2017
Practice Address - Country:US
Practice Address - Phone:214-826-8822
Practice Address - Fax:214-826-9792
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL33732085N0700X, 2085R0202X
MN470342085N0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX177042201Medicaid
TX177042202Medicaid
TX177042204Medicaid
MN726165900Medicaid
TX177042205Medicaid
TX177042203Medicaid
TX177042205Medicaid
TXP00330370Medicare PIN
TX177042203Medicaid
TX177042201Medicaid
MN726165900Medicaid
TX8G1646Medicare PIN