Healthcare Provider Details

I. General information

NPI: 1164450508
Provider Name (Legal Business Name): JAMES ERASMUS KENDRICK IV MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2006
Last Update Date: 04/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 N ORANGE AVE SUITE 800
ORLANDO FL
32804-4648
US

IV. Provider business mailing address

2501 N ORANGE AVE SUITE 800
ORLANDO FL
32804-4648
US

V. Phone/Fax

Practice location:
  • Phone: 407-303-2422
  • Fax: 407-303-2435
Mailing address:
  • Phone: 407-303-2422
  • Fax: 407-303-2435

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License NumberME104557
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: