Organization
BRUCE S KENNEDY MD PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRUCE S KENNEDY MD (PRESIDENT)
(386) 673-2547
Entity
Organization
Contact information
Practice address
411 LAKEBRIDGE PLAZA DR, SUITE B, ORMOND BEACH, FL 32174-5157
(386) 673-2547
(386) 673-6141
Mailing address
411 LAKEBRIDGE PLAZA DR, SUITE B, ORMOND BEACH, FL 32174-5157
(386) 673-2547
(386) 673-6141
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
ME0043975
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
02516
BCBS
FL
Enumeration date
05/11/2006
Last updated
08/22/2020
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