MEDICARE: DR. ERICK GREGORY KENT D.O.

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	208000000X	Pediatrics Physician	OS0007368	FL

General Provider Information

NPI Number	:	1518010453
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ERICK GREGORY KENT D.O.

Provider Business Mailing Address
First Line	:	238 BROOKLEY AVENUE
Second Line	:
City	:	BOLLING AIR FORCE BASE
State	:	DC
Zip	:	20032
Country	:	US
Telephone Number	:	202-404-5866
Fax Number	:

Provider Business Practice Location Address
First Line	:	238 BROOKLEY AVENUE
Second Line	:
City	:	BOLLING AIR FORCE BASE
State	:	DC
Zip	:	20032
Country	:	US
Telephone Number	:	202-404-5866
Fax Number	:

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

Provider Enumeration Date	:	01/22/2007
Last Update Date	:	07/08/2007

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