Provider Demographics
NPI:1760849103
Name:KENNEDY, BENJAMIN SMITH (MD)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:SMITH
Last Name:KENNEDY
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 1:7565 NE ORCHID BAY TER
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33487-1703
Mailing Address - Country:US
Mailing Address - Phone:561-997-6027
Mailing Address - Fax:561-912-9306
Practice Address - Street 1:7565 NE ORCHID BAY TER
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33487-1703
Practice Address - Country:US
Practice Address - Phone:561-997-6027
Practice Address - Fax:561-912-9306
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-15
Last Update Date:2016-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME13671207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology