Provider Demographics
NPI:1417061250
Name:KENT, RONALD S (MD)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:S
Last Name:KENT
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 1:1112 WALDEN WAY
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39402-7056
Mailing Address - Country:US
Mailing Address - Phone:601-310-9811
Mailing Address - Fax:601-310-9811
Practice Address - Street 1:1112 WALDEN WAY
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39402-7056
Practice Address - Country:US
Practice Address - Phone:601-310-9811
Practice Address - Fax:601-310-9811
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS08370208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS1559008OtherAMERICAN ADMIN GROUP
MS00115703Medicaid
LA1973297Medicaid
MS00115703Medicaid
MS370000232Medicare PIN
MS370009778OtherRAILROAD MEDICARE