Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | DN15901 | FL |
N | 1223G0001X | General Practice | DN15901 | FL |
N | 213EG0000X | General Practice | DN15901 | FL |
NPI | 1003882184 |
---|---|
Provider Name | Dr. Kenneth A Mertz JR. |
First Address | Jacksonville, FL 32211-9230 |
Second Address | Jacksonville, FL 32216 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/02/2006 |
Last Update Date | 26/02/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
075717900 | (05) | FL |
0757179-00 | (05) | FL |
801488195A | (05) | GA |