Healthcare Provider Details

I. General information

NPI: 1760465348
Provider Name (Legal Business Name): PAUL SCOTT KENYON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/28/2005
Last Update Date: 01/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 S EAST AVE
JACKSON MI
49201-2412
US

IV. Provider business mailing address

150 S EAST AVE
JACKSON MI
49201-2412
US

V. Phone/Fax

Practice location:
  • Phone: 517-787-6924
  • Fax: 517-787-8335
Mailing address:
  • Phone: 517-787-6924
  • Fax: 517-787-8335

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number49140
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: