Provider Demographics
NPI:1336134634
Name:LEIFER, KENT N (MD)
Entity Type:Individual
Prefix:
First Name:KENT
Middle Name:N
Last Name:LEIFER
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 1:375 S COURTENAY PKWY
Mailing Address - Street 2:UNIT 4
Mailing Address - City:MERRITT ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32952-4886
Mailing Address - Country:US
Mailing Address - Phone:321-452-4730
Mailing Address - Fax:321-453-6681
Practice Address - Street 1:375 S COURTENAY PKWY
Practice Address - Street 2:UNIT 4
Practice Address - City:MERRITT ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32952-4886
Practice Address - Country:US
Practice Address - Phone:321-452-4730
Practice Address - Fax:321-453-6681
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-13
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME24381207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAETNA 4028111OtherAETNA INSURANCE
FL79065Medicare ID - Type Unspecified
FLAETNA 4028111OtherAETNA INSURANCE