Provider Demographics
NPI:1528046976
Name:KENDALL, BRIAN SCOTT (MD)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:SCOTT
Last Name:KENDALL
Suffix:
Gender:M
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:PO BOX 650859 DEPT 710
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75265-1149
Mailing Address - Country:US
Mailing Address - Phone:409-772-0620
Mailing Address - Fax:409-772-1084
Practice Address - Street 1:301 UNIVERSITY BLVD
Practice Address - Street 2:
Practice Address - City:GALVESTON
Practice Address - State:TX
Practice Address - Zip Code:77555-2084
Practice Address - Country:US
Practice Address - Phone:409-772-2222
Practice Address - Fax:210-558-6289
Is Sole Proprietor?:No
Enumeration Date:2006-01-05
Last Update Date:2022-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK5129207ZP0102X, 207ZC0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZC0006XAllopathic & Osteopathic PhysiciansPathologyClinical Pathology
No207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX214182201Medicaid
TXTXB106447Medicare PIN