Provider Demographics
NPI:1609868900
Name:BRUMMEL-SMITH, KENNETH V (MD)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:V
Last Name:BRUMMEL-SMITH
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1115 W CALL ST
Mailing Address - Street 2:SUITE 1121C
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32306-4300
Mailing Address - Country:US
Mailing Address - Phone:850-645-9350
Mailing Address - Fax:850-645-0577
Practice Address - Street 1:4449 MEANDERING WAY
Practice Address - Street 2:FSU SENIORHEALTH AT WOK
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-5740
Practice Address - Country:US
Practice Address - Phone:850-644-1543
Practice Address - Fax:850-645-0577
Is Sole Proprietor?:No
Enumeration Date:2005-08-22
Last Update Date:2016-12-14
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Provider Licenses
StateLicense IDTaxonomies
FLME89569207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORA45277Medicare UPIN