Individual
KERRY VAUGHN RIFKIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2140 KINGSLEY AVE, SUITE 14, ORANGE PARK, FL 32073-5180
(904) 276-7997
(904) 276-7559
Mailing address
2140 KINGSLEY AVE, SUITE 14, ORANGE PARK, FL 32073-5180
(904) 276-7997
(904) 276-7559
Taxonomy
Speciality
Code
Description
License number
State
2086S0129X
Vascular Surgery Physician
G4046
TX
2086S0129X
Vascular Surgery Physician
Primary
ME0041529
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
020016680
RAILROAD MEDICARE
FL
05
—
067441900
—
FL
01
—
15764
BCBS OF FLORIDA
FL
Enumeration date
05/23/2006
Last updated
03/04/2020
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