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General NPI Number Information
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NPI Number | 1235283854
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Entity Type | Organization
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Legal Business Name | KEVIENE RUTHERFORD MD PA
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Dates
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Enumeration Date | 01/22/2007
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Last Update Date | 04/20/2012
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Provider Practice Location Address
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Address Line | 10075 S JOG RD SUITE 311
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City | BOYNTON BEACH
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State | FL
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Zip | 33437-3535
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Country | US
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Telephone | 561-732-8355
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Fax | 561-732-8358
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Provider Business Mailing Address
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Address Line | 10075 JOG ROAD SUITE 311
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City | BOYNTON BEACH
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State | FL
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Zip | 33437-3537
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Country | US
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Telephone | 561-732-8355
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Fax | 561-732-8358
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. KEVIENE RUTHERFORD
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Credential | MD
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Telephone | 561-732-8355
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | ME87247
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License Number State | FL
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