Provider Demographics
NPI:1548206618
Name:KEVILL, JOHN W (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:W
Last Name:KEVILL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:615 E PRINCETON STREET
Mailing Address - Street 2:SUITE 540
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32803-1424
Mailing Address - Country:US
Mailing Address - Phone:407-303-8127
Mailing Address - Fax:407-303-8197
Practice Address - Street 1:615 E PRINCETON STREET
Practice Address - Street 2:SUITE 540
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-1424
Practice Address - Country:US
Practice Address - Phone:407-303-8127
Practice Address - Fax:407-303-8197
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2019-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1140722084N0400X, 2084N0402X
WABC606868202084N0400X
MO20190170862084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL007208200Medicaid
LA1150096Medicaid
LA4M549F610Medicare PIN
FLGR399ZMedicare PIN