Individual
DR. KEVIN RAYMOND GENDREAU
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
110 LIBERTY ST, BROCKTON, MA 02301-5674
(508) 894-0400
(508) 565-0097
Mailing address
110 LIBERTY ST STE 180, BROCKTON, MA 02301-5674
(508) 894-0766
(508) 565-0097
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
270162
MA
207Q00000X
Family Medicine Physician
MD17833
RI
207QB0002X
Obesity Medicine (Family Medicine) Physician
Primary
270162
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110118525A
—
MA
Enumeration date
06/11/2014
Last updated
03/10/2022
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