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General NPI Number Information
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NPI Number | 1033804265
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Entity Type | Organization
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Legal Business Name | TCMMD LLC
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Dates
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Enumeration Date | 04/05/2023
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Last Update Date | 11/05/2025
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Provider Practice Location Address
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Address Line | 2011 S 25TH ST STE 206
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City | FORT PIERCE
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State | FL
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Zip | 34947-4795
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Country | US
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Telephone | 772-237-3600
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Fax | 772-236-7887
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Provider Business Mailing Address
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Address Line | 2011 S 25TH ST STE 206
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City | FORT PIERCE
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State | FL
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Zip | 34947-4795
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Country | US
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Telephone | 772-237-3600
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Fax | 772-236-7887
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. MATTHEW SCOTT KUYKENDALL SR.
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Credential |
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Telephone | 772-410-7751
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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