Healthcare Provider Details

I. General information

NPI: 1053675868
Provider Name (Legal Business Name): ALEXANDER WOODWARD KENNON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2012
Last Update Date: 10/19/2020
Certification Date: 10/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

727 US HIGHWAY 27 S
SEBRING FL
33870-2169
US

IV. Provider business mailing address

727 US HIGHWAY 27 S
SEBRING FL
33870-2169
US

V. Phone/Fax

Practice location:
  • Phone: 863-385-7183
  • Fax:
Mailing address:
  • Phone: 863-385-7183
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License NumberME136268
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberME136268
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: