MEDICARE: KENNETH RAYE WASHINGTON 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	207ZP0213X	Pediatric Pathology Physician	ME37564	FL

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

General Provider Information

NPI Number	:	1417935222
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENNETH RAYE WASHINGTON MD

Provider Business Mailing Address
First Line	:	201 6TH ST E
Second Line	:
City	:	TIERRA VERDE
State	:	FL
Zip	:	33715-2243
Country	:	US
Telephone Number	:	727-867-1517
Fax Number	:

Provider Business Practice Location Address
First Line	:	601 5TH ST S
Second Line	:
City	:	ST PETERSBURG
State	:	FL
Zip	:	33701
Country	:	US
Telephone Number	:	727-767-4341
Fax Number	:	727-767-8516

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

Provider Enumeration Date	:	01/03/2006
Last Update Date	:	03/03/2010

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