Provider Demographics
NPI:1174524441
Name:BRIGHT, KEVIN EDWARD (MD)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:EDWARD
Last Name:BRIGHT
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 1:5959 GATEWAY BLVD W
Mailing Address - Street 2:STE120
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79925-3331
Mailing Address - Country:US
Mailing Address - Phone:915-779-1716
Mailing Address - Fax:915-771-6558
Practice Address - Street 1:1600 MEDICAL CTR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-5002
Practice Address - Country:US
Practice Address - Phone:915-544-1350
Practice Address - Fax:915-544-6740
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2008-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK7250207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX045712901Medicaid
TX8A2961OtherBCBS
TX045712901Medicaid
TX8768K0Medicare ID - Type Unspecified