Healthcare Provider Details

I. General information

NPI: 1043288707
Provider Name (Legal Business Name): GILBERT KENNEDY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 HEALTH PARK BLVD
ST AUGUSTINE FL
32086-5784
US

IV. Provider business mailing address

8068 CATAWBA DRIVE
ACKSONVILLE FL
32217
US

V. Phone/Fax

Practice location:
  • Phone: 904-826-4700
  • Fax:
Mailing address:
  • Phone: 904-448-8647
  • Fax: 904-448-8647

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberME0088046
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: