Individual
KENNETH DERBENWICK
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
350 N CLYDE MORRIS BLVD, DAYTONA BEACH, FL 32114
(386) 238-3200
Mailing address
PO BOX 9671, DAYTONA BEACH, FL 32120
(386) 615-4015
Taxonomy
Speciality
Code
Description
License number
State
173000000X
Legal Medicine
Primary
ME0026485
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
ME0026485
VHN
FL
Enumeration date
03/23/2006
Last updated
07/08/2007
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