Individual
KENNETH S MEYER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
820 PRUDENTIAL DR STE 515, CREDENTIALING DEPARTMENT, JACKSONVILLE, FL 32207-8207
(904) 396-4886
(904) 398-0496
Mailing address
PO BOX 45443, SALT LAKE CITY, UT 84145-0443
(904) 202-1032
(904) 376-4107
Taxonomy
Speciality
Code
Description
License number
State
207RI0200X
Infectious Disease Physician
Primary
ME59676
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
053516800
—
FL
01
—
P00265784
RR MEDICARE
FL
Enumeration date
03/15/2006
Last updated
12/31/2018
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