Kevin B. Waldrep, M.D.,PLLC

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

Legal business name

KEVIN B. WALDREP, M.D.,PLLC

Practice address

7777 Forest LN Ste B111
Dallas, TX 75230-2539

Phone

(972) 566-4204

NPI assigned

May 28, 2020

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Francisco A Rodriguez

Title

Credential/Director

Phone

(972) 566-4204

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Kevin Bradley Waldrep, M.D.

  • Surgery Physician
  • Dallas, TX
  • NPI 1790912061
  Medicare reassignment NPD
• Ronald J Aronoff, MD

  • Surgery Physician
  • Dallas, TX
  • NPI 1982770558
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1590624000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1591920000000",
    "number": "1841814506",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7777 FOREST LN STE B111",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752302539",
            "telephone_number": "972-566-4204"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7777 FOREST LN STE B111",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752302539",
            "telephone_number": "972-566-4204"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KEVIN B. WALDREP, M.D.,PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-05-28",
        "last_updated": "2020-06-12",
        "certification_date": "2020-06-12",
        "status": "A",
        "authorized_official_last_name": "RODRIGUEZ",
        "authorized_official_first_name": "FRANCISCO",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "CREDENTIAL/DIRECTOR",
        "authorized_official_telephone_number": "972-566-4204",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "EHR",
            "affiliation": "N",
            "endpointDescription": "Electronic Medical Record",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "7777 Forest Ln Ste B111",
            "city": "Dallas",
            "state": "TX",
            "country_code": "US",
            "postal_code": "752302539",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Samout Kettavong, CCC-SLP
• Anton Sebastian Ketterer, MD
• Michele A Kettles, MD
• Arunima Jayaram Ketu
• Heejo Keum
• Kevin Joseph Kearns, M.D., Medical Corporation
• Kevin Y Kim MD PA
• Kevmed, LLC
• Key Autism Services TX, LLC
• Ann S Key, LPC-S

• Surgery Physician in Dallas, TX
• Providers in Dallas, TX by specialty
• Surgery Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.