Provider Demographics
NPI:1598744500
Name:AMAZON, KIP (MD)
Entity Type:Individual
Prefix:DR
First Name:KIP
Middle Name:
Last Name:AMAZON
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 1:7111 FAIRWAY DR
Mailing Address - Street 2:SUITE 400
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33418-4204
Mailing Address - Country:US
Mailing Address - Phone:561-712-6265
Mailing Address - Fax:561-712-7349
Practice Address - Street 1:20900 BISCAYNE BLVD
Practice Address - Street 2:
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180-1407
Practice Address - Country:US
Practice Address - Phone:305-682-7360
Practice Address - Fax:305-682-3640
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME33480207ZP0102X, 207ZP0104X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207ZP0104XAllopathic & Osteopathic PhysiciansPathologyChemical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL95748WMedicare PIN
FLD63592Medicare UPIN