Provider Demographics
NPI:1235437575
Name:FOLLMAR, KENNETH EARL III (MD)
Entity Type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:EARL
Last Name:FOLLMAR
Suffix:III
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 1:1294 W 6TH ST STE 102
Mailing Address - Street 2:
Mailing Address - City:SAN PEDRO
Mailing Address - State:CA
Mailing Address - Zip Code:90731-2997
Mailing Address - Country:US
Mailing Address - Phone:310-944-1108
Mailing Address - Fax:
Practice Address - Street 1:1294 W 6TH ST STE 102
Practice Address - Street 2:
Practice Address - City:SAN PEDRO
Practice Address - State:CA
Practice Address - Zip Code:90731-2997
Practice Address - Country:US
Practice Address - Phone:310-944-1108
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-10
Last Update Date:2013-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA103360208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics