Provider Demographics
NPI:1366408924
Name:KYLE, DOUGLAS E JR (MD)
Entity type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:E
Last Name:KYLE
Suffix:JR
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 1:2451 S FM 51 STE 300
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:TX
Mailing Address - Zip Code:76234-3861
Mailing Address - Country:US
Mailing Address - Phone:940-627-4216
Mailing Address - Fax:940-627-4709
Practice Address - Street 1:2451 S FM 51 STE 300
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:TX
Practice Address - Zip Code:76234-3861
Practice Address - Country:US
Practice Address - Phone:940-627-4216
Practice Address - Fax:940-627-4709
Is Sole Proprietor?:No
Enumeration Date:2006-04-24
Last Update Date:2019-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH6361207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX142092901Medicaid
160051774OtherRR MCARE
TX8508M0OtherBCBSTX