Healthcare Provider Details

I. General information

NPI: 1205808516
Provider Name (Legal Business Name): KENNETH JOSEPH BARON PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2006
Last Update Date: 01/09/2025
Certification Date: 01/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3250 ZEMKE AVE #1078 6TH MEDICAL GROUP
MACDILL AFB FL
33621
US

IV. Provider business mailing address

3250 ZEMKE AVE #1078 6TH MEDICAL GROUP
MACDILL AFB FL
33621
US

V. Phone/Fax

Practice location:
  • Phone: 138-827-9650
  • Fax: 813-827-9099
Mailing address:
  • Phone: 138-827-9650
  • Fax: 813-827-9099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA 3692
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA 3692
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: