Provider Demographics
NPI:1144225244
Name:KEPES, KATHRYN LUCILLE (MD)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:LUCILLE
Last Name:KEPES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 N ALEXANDER ST
Mailing Address - Street 2:
Mailing Address - City:PLANT CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33563-4303
Mailing Address - Country:US
Mailing Address - Phone:813-719-7705
Mailing Address - Fax:813-719-7906
Practice Address - Street 1:303 N ALEXANDER ST
Practice Address - Street 2:
Practice Address - City:PLANT CITY
Practice Address - State:FL
Practice Address - Zip Code:33563-4303
Practice Address - Country:US
Practice Address - Phone:813-719-7705
Practice Address - Fax:813-719-7906
Is Sole Proprietor?:No
Enumeration Date:2005-06-15
Last Update Date:2013-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME00452732085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL008130800Medicaid
FL30766OtherBCBS
FL008130800Medicaid
FL30766OtherBCBS