Individual
KENNETH L MASKELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
820 PRUDENTIAL DR STE 304, JACKSONVILLE, FL 32207-8205
(904) 202-3860
(904) 202-3846
Mailing address
PO BOX 746638, ATLANTA, GA 30374-6638
(904) 202-2092
(904) 376-4075
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
036145978
IL
207R00000X
Internal Medicine Physician
ME170543
FL
208M00000X
Hospitalist Physician
036145978
IL
208M00000X
Hospitalist Physician
Primary
ME170543
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036145978
—
IL
Enumeration date
04/07/2015
Last updated
03/07/2025
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