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General NPI Number Information
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NPI Number | 1588656904
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Entity Type | Individual
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Provider Name | KENNETH J. BREGG M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/22/2005
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Last Update Date | 06/19/2018
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Provider Practice Location Address
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Address Line | 1921 WALDEMERE ST STE 310
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City | SARASOTA
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State | FL
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Zip | 34239
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Country | US
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Telephone | 941-917-5400
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Fax | 941-917-5420
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Provider Business Mailing Address
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Address Line | PO BOX 863407
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City | ORLANDO
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State | FL
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Zip | 32886-3407
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Country | US
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Telephone | 941-917-2600
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Fax | 941-917-7884
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number | ME62142
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License Number State | FL
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