Individual
DR. ROBERT G KETTRICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4600 TOUCHTON RD E, SUITE 2500, JACKSONVILLE, FL 32246-8299
(904) 232-4262
(904) 232-4230
Mailing address
CORPORATE CREDENTIALING, P.O. BOX 269, WILMINGTON, DE 19899
(302) 651-5938
(302) 651-6077
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
C10002939
DE
207L00000X
Anesthesiology Physician
Primary
ME72828
FL
Other
Enumeration date
02/26/2007
Last updated
07/08/2007
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