Provider Demographics
NPI:1477632453
Name:KENNEDY, JAMES R (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:R
Last Name:KENNEDY
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:327 COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95401-5117
Mailing Address - Country:US
Mailing Address - Phone:707-568-2800
Mailing Address - Fax:707-568-2804
Practice Address - Street 1:327 COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95401-5117
Practice Address - Country:US
Practice Address - Phone:707-568-2800
Practice Address - Fax:707-568-2804
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2009-12-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG94082084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG9408OtherSTATE OF CALIFORNIA MEDICAL LICENSE
CAG9408OtherSTATE OF CALIFORNIA MEDICAL LICENSE