Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207N00000X | Dermatologist | ME136268 | FL |
Y | 207ND0101X | MOHS-Micrographic Surgeon | ME136268 | FL |
NPI | 1053675868 |
---|---|
Provider Name | Alexander Woodward Kennon |
First Address | Sebring, FL 33870-2169 |
Second Address | Sebring, FL 33870-2169 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/06/2012 |
Last Update Date | 19/10/2020 |