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General NPI Number Information
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NPI Number | 1700150943
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Entity Type | Organization
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Legal Business Name | KENNETH W FIELDS DERMATOLOGY PA
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Dates
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Enumeration Date | 03/06/2012
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Last Update Date | 03/06/2012
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Provider Practice Location Address
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Address Line | 5100 TAMIAMI TRAIL N 102
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City | NAPLES
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State | FL
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Zip | 34103-2810
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Country | US
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Telephone | 239-262-7546
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Fax | 239-262-2403
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Provider Business Mailing Address
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Address Line | 5100 TAMIAMI TRAIL N 102
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City | NAPLES
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State | FL
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Zip | 34103-2810
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Country | US
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Telephone | 239-262-7546
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Fax | 239-262-2403
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Authorized Official
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Title or Position | MD
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Name | KENNETH FIELDS
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Credential | MD
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Telephone | 239-262-7546
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | ME0045217
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License Number State | FL
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