Individual
KENNETH A SON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1348 S 18TH ST, FERNANDINA BEACH, FL 32034-4785
(904) 227-2003
(904) 277-2006
Mailing address
PO BOX 2421, SALT LAKE CITY, UT 84110-2421
(904) 202-1034
(904) 376-4107
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
043782
GA
208800000X
Urology Physician
Primary
ME111180
FL
208M00000X
Hospitalist Physician
ME111180
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004787700
—
FL
05
—
00748833A
—
GA
01
—
P01265088
RAILROAD MEDICARE
FL
01
—
TJ447
MEDICARE HF
FL
Enumeration date
09/27/2006
Last updated
08/22/2024
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