Provider Demographics
NPI:1619935384
Name:GARNER, KYLE L (MD)
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:L
Last Name:GARNER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1950 ARLINGTON ST
Mailing Address - Street 2:SUITE 203
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34239-3507
Mailing Address - Country:US
Mailing Address - Phone:941-379-6331
Mailing Address - Fax:941-379-5343
Practice Address - Street 1:1950 ARLINGTON ST
Practice Address - Street 2:SUITE 203
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-3507
Practice Address - Country:US
Practice Address - Phone:941-379-6331
Practice Address - Fax:941-379-5343
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2012-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME94509207Q00000X, 207VX0000X, 207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL276640000Medicaid
56493OtherBUE CROSS BLUE SHIELD