Healthcare Provider Details

I. General information

NPI: 1568430486
Provider Name (Legal Business Name): KENNETH WAYNE KOREY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2006
Last Update Date: 04/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1133 SEMINOLE DR
ROCKLEDGE FL
32955-2836
US

IV. Provider business mailing address

PO BOX 11406
BELFAST ME
04915-4005
US

V. Phone/Fax

Practice location:
  • Phone: 321-637-2975
  • Fax: 321-433-1935
Mailing address:
  • Phone: 321-637-2975
  • Fax: 321-433-1935

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberME28087
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: