Individual
KENLEY BRENT DAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
17222 HOSPITAL BLVD, SUITE 326, BROOKSVILLE, FL 34601-8925
(352) 544-6145
(352) 688-9189
Mailing address
17222 HOSPITAL BLVD STE 242, BROOKSVILLE, FL 34601-8925
(352) 544-6145
(352) 688-9189
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
ME94305
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
274800200
—
FL
01
—
30162
BCBS
FL
01
—
30162Y
MEDICARE ID
FL
Enumeration date
08/16/2006
Last updated
10/03/2022
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