Provider Demographics
NPI:1124021464
Name:FAWCETT, KENNEDY CECIL (MD)
Entity Type:Individual
Prefix:DR
First Name:KENNEDY
Middle Name:CECIL
Last Name:FAWCETT
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 1:1515 WILSON AVE
Mailing Address - Street 2:
Mailing Address - City:AMES
Mailing Address - State:IA
Mailing Address - Zip Code:50010-5363
Mailing Address - Country:US
Mailing Address - Phone:515-232-2868
Mailing Address - Fax:443-328-1283
Practice Address - Street 1:1515 WILSON AVE
Practice Address - Street 2:
Practice Address - City:AMES
Practice Address - State:IA
Practice Address - Zip Code:50010-5363
Practice Address - Country:US
Practice Address - Phone:515-232-2868
Practice Address - Fax:443-328-1283
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-05-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA15629207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine