Individual
EDMUND KENNEDY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1501 S WALDRON RD, STE 107, FORT SMITH, AR 72903-2574
(479) 573-7980
(479) 573-7981
Mailing address
PO BOX 402319, ATLANTA, GA 30384-2319
(479) 709-7399
(479) 709-7053
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
R3286
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100055840A
—
OK
05
—
107739001
—
AR
Enumeration date
02/28/2008
Last updated
08/13/2010
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