Provider Demographics
NPI:1215965199
Name:KENT, DAVID A (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:A
Last Name:KENT
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2375 S COBALT POINT WAY STE 102
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-8029
Mailing Address - Country:US
Mailing Address - Phone:208-863-0860
Mailing Address - Fax:208-954-5595
Practice Address - Street 1:5561 N GLENWOOD ST STE B
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:ID
Practice Address - Zip Code:83714-1336
Practice Address - Country:US
Practice Address - Phone:208-863-0860
Practice Address - Fax:208-954-5595
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IDM56092084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1123528Medicare PIN