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Kent Philip Brantly

Family Medicine

Allopathic & Osteopathic Physicians

1500 S Main St, Fort Worth, TX 76104-4917

PECOS Enrollment

This provider is enrolled in PECOS as KENT BRANTLY.

Based on the most recent information from CMS, provider Kent Philip Brantly is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records 3 days ago.

Profile Details

Provider ID
1063745768
Provider Type
Individual
Full Name
Brantly, Kent Philip
Title
Dr.
Credential
M.D.

Gender
Male
Sole Proprietor
No
Enumeration Date
9/12/2009
Last Updated
7/7/2015

Contact Information

Practice Location

1500 S Main St, Fort Worth, TX 76104-4917

(817) 702-2396

Unlisted Fax

Mailing Location

1617 Hemphill St, Fort Worth, TX 76104-4709

(817) 702-2396

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 207Q00000X Primary	Description Family Medicine Allopathic & Osteopathic Physicians	License P0816 Texas

Kent Philip Brantly

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Murthy, Kenton Kumar

Walker, Thomas Lawrence

Zeiser, Michael Jonathan

Naseer, Shazli

Jackson, Masheika S

Koch, Mark

Abadie Sole, Montserrat

Katzen, Kenneth Lee

Liddle, Joseph Nathan

Diaz De Leon, Sarah Elizabeth