Provider Demographics
NPI:1992056048
Name:EWANE, KENNETH A (MD)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:A
Last Name:EWANE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 4948
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78523-4948
Mailing Address - Country:US
Mailing Address - Phone:956-435-0344
Mailing Address - Fax:956-435-0420
Practice Address - Street 1:800 W JEFFERSON ST STE 170
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78520-6300
Practice Address - Country:US
Practice Address - Phone:956-435-0344
Practice Address - Fax:956-435-0420
Is Sole Proprietor?:No
Enumeration Date:2012-09-28
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXQ2277208800000X
LA207212174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
No174400000XOther Service ProvidersSpecialist