Provider Demographics
NPI:1063641827
Name:WEBSTER, KENNETH DANIEL (MD)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:DANIEL
Last Name:WEBSTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3825 S.W. 86TH ST.
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32608-7901
Mailing Address - Country:US
Mailing Address - Phone:352-505-5687
Mailing Address - Fax:352-505-5687
Practice Address - Street 1:3825 SW 86TH ST.
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32608-7901
Practice Address - Country:US
Practice Address - Phone:352-505-5687
Practice Address - Fax:352-505-5687
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-14
Last Update Date:2009-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.025957207VX0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic Oncology