Individual
DR. JASIRI KENNEDY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1325 BROADWAY ST, ROCKPORT, TX 78382-3333
(361) 729-0646
(361) 729-8854
Mailing address
1325 BROADWAY ST, ROCKPORT, TX 78382-3333
(361) 729-0646
(361) 729-8854
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
036-098701
IL
207P00000X
Emergency Medicine Physician
Primary
A81294
CA
207P00000X
Emergency Medicine Physician
L4016
TX
207Q00000X
Family Medicine Physician
L4016
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A812940
—
CA
05
—
036098701
—
IL
01
—
3932056
BLUE SHIELD
IL
Enumeration date
01/23/2006
Last updated
12/19/2008
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