Healthcare Provider Details

I. General information

NPI: 1265613244
Provider Name (Legal Business Name): KENNETH A. NEIFIELD, M.D., P.L.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/19/2007
Last Update Date: 01/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2191 9TH AVE N SUITE 110
SAINT PETERSBURG FL
33713-7147
US

IV. Provider business mailing address

2191 9TH AVE N SUITE 110
SAINT PETERSBURG FL
33713-7147
US

V. Phone/Fax

Practice location:
  • Phone: 727-820-7778
  • Fax: 727-820-7779
Mailing address:
  • Phone: 727-820-7778
  • Fax: 727-820-7779

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME64972
License Number StateFL

VIII. Authorized Official

Name: TATIANA CHUMBLEY
Title or Position: ADMINISTRATOR
Credential:
Phone: 727-498-8699