Provider Demographics
NPI:1467610204
Name:KAZEMFAR, KRISTY CASEY (DO)
Entity Type:Individual
Prefix:DR
First Name:KRISTY
Middle Name:CASEY
Last Name:KAZEMFAR
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 FORTENBERRY RD
Mailing Address - Street 2:STE A1
Mailing Address - City:MERRITT ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32952-3601
Mailing Address - Country:US
Mailing Address - Phone:321-459-1192
Mailing Address - Fax:321-459-2304
Practice Address - Street 1:255 FORTENBERRY RD
Practice Address - Street 2:STE A1
Practice Address - City:MERRITT ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32952-3601
Practice Address - Country:US
Practice Address - Phone:321-459-1192
Practice Address - Fax:321-459-2304
Is Sole Proprietor?:No
Enumeration Date:2008-05-29
Last Update Date:2017-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS11616207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL005799800Medicaid
FL005799800Medicaid