Healthcare Provider Details

I. General information

NPI: 1760849103
Provider Name (Legal Business Name): BENJAMIN SMITH KENNEDY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/15/2016
Last Update Date: 01/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7565 NE ORCHID BAY TER
BOCA RATON FL
33487-1703
US

IV. Provider business mailing address

7565 NE ORCHID BAY TER
BOCA RATON FL
33487-1703
US

V. Phone/Fax

Practice location:
  • Phone: 561-997-6027
  • Fax: 561-912-9306
Mailing address:
  • Phone: 561-997-6027
  • Fax: 561-912-9306

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberME13671
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: