Individual
KEVIN K. NIEBAUM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
2080 CHILD ST, JACKSONVILLE, FL 32214-3647
(904) 542-9703
(904) 542-9483
Mailing address
2080 CHILD ST, JACKSONVILLE, FL 32214-3600
(904) 542-9703
(904) 542-9483
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
047353
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000834809D
—
GA
Enumeration date
04/27/2006
Last updated
02/06/2025
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