MEDICARE: KENNETH V BRUMMEL-SMITH 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	207QG0300X	Geriatric Medicine (Family Medicine) Physician	ME89569	FL

General Provider Information

NPI Number	:	1609868900
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENNETH V BRUMMEL-SMITH MD

Provider Business Mailing Address
First Line	:	1115 W CALL ST
Second Line	:	SUITE 1121C
City	:	TALLAHASSEE
State	:	FL
Zip	:	32306-4300
Country	:	US
Telephone Number	:	850-645-9350
Fax Number	:	850-645-0577

Provider Business Practice Location Address
First Line	:	4449 MEANDERING WAY
Second Line	:	FSU SENIORHEALTH AT WOK
City	:	TALLAHASSEE
State	:	FL
Zip	:	32308-5740
Country	:	US
Telephone Number	:	850-644-1543
Fax Number	:	850-645-0577

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

Provider Enumeration Date	:	08/22/2005
Last Update Date	:	12/14/2016

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