MEDICARE: KENNETH A SON MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208800000X	Urology Physician	043782	GA
2	208M00000X	Hospitalist Physician	ME111180	FL
3	208800000X	Urology Physician	ME111180	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	TJ447	OTHER	FL	MEDICARE HF
3	P01265088	OTHER	FL	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1417048331
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENNETH A SON MD

Provider Business Mailing Address
First Line	:	PO BOX 2421
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84110-2421
Country	:	US
Telephone Number	:	904-202-1034
Fax Number	:	904-376-4107

Provider Business Practice Location Address
First Line	:	1348 S 18TH ST
Second Line	:
City	:	FERNANDINA BEACH
State	:	FL
Zip	:	32034-4785
Country	:	US
Telephone Number	:	904-227-2003
Fax Number	:	904-277-2006

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/27/2006
Last Update Date	:	08/22/2024

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Directions to “ KENNETH A SON MD” Practice Location

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