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Individual

KENNETH WILSON BACKSTRAND

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
2721 DEL PRADO BLVD S, CAPE CORAL, FL 33904-5781
(239) 242-8010
(239) 242-8020
Mailing address
40 BARKLEY CIR STE 3, FORT MYERS, FL 33907-4518
(239) 226-0910
(239) 226-0912

Taxonomy

Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
ME0050622
FL
207LP2900X
Pain Medicine (Anesthesiology) Physician
Primary
ME50622
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
046206300
FL
Enumeration date
10/11/2005
Last updated
03/08/2018
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