Individual
KENNETH S WAYNE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
32349
IA
207RP1001X
Pulmonary Disease Physician
32349
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0169417
—
IA
01
—
110166527
RR MEDICARE
IA
05
—
1169417
—
IA
05
—
1174500151
—
IA
05
—
2169417
—
IA
Enumeration date
12/29/2005
Last updated
05/17/2012
Update your record
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