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Individual

KENNETH KAY HINES

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
350 N CLYDE MORRIS BLVD, DAYTONA BEACH, FL 32114-2733
(386) 238-3229
(386) 238-3292
Mailing address
350 N CLYDE MORRIS BLVD, DAYTONA BEACH, FL 32114-2733

Taxonomy

Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
44229
CO
2085R0202X
Diagnostic Radiology Physician
M-9423
ID
2085R0202X
Diagnostic Radiology Physician
Primary
ME54914
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
003325100
FL
01
09285
BCBS
FL
01
1477512747
TRICARE
FL
Enumeration date
03/23/2006
Last updated
06/13/2023
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