Individual
DR. KENNETH VAUGHN ADAMS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
14534 OLD SAINT AUGUSTINE RD STE 3420, JACKSONVILLE, FL 32258-2616
(904) 493-8001
(904) 338-0852
Mailing address
PO BOX 746652, ATLANTA, GA 30374-6652
(904) 720-0599
(904) 376-4036
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
ME42068
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
052984200
—
FL
01
—
110086217
RR MEDICARE
FL
Enumeration date
08/15/2005
Last updated
11/01/2022
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