Provider Demographics
NPI:1295022861
Name:SAUL, KENNETH DANIEL (MD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:DANIEL
Last Name:SAUL
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 1:5002 HIGHWAY 39 N
Mailing Address - Street 2:BLDG A
Mailing Address - City:MERIDIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39301-1078
Mailing Address - Country:US
Mailing Address - Phone:601-512-0500
Mailing Address - Fax:601-512-0505
Practice Address - Street 1:5002 HIGHWAY 39 N BLDG A
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:MS
Practice Address - Zip Code:39301-1078
Practice Address - Country:US
Practice Address - Phone:601-512-0500
Practice Address - Fax:601-512-0505
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-05
Last Update Date:2016-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS22764207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS497603ZUUOtherMEDICARE ID