Individual
DR. KENT RICHARDSON CORRAL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4700 N HABANA AVE, SUITE 103, TAMPA, FL 33614-7160
(813) 348-0224
(813) 872-6792
Mailing address
803 W LOWRY LN, TAMPA, FL 33604-4711
(813) 348-0224
(813) 872-6792
Taxonomy
Speciality
Code
Description
License number
State
173000000X
Legal Medicine
Primary
ME0035361
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
219133
AVMED
FL
01
—
30392
BCBS
FL
Enumeration date
02/08/2006
Last updated
01/15/2013
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