Provider Demographics
NPI:1790736874
Name:MORSE, KENNETH H (MD)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:H
Last Name:MORSE
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 1:1500 SE 17TH ST
Mailing Address - Street 2:600
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-4621
Mailing Address - Country:US
Mailing Address - Phone:352-732-8955
Mailing Address - Fax:352-732-7999
Practice Address - Street 1:1500 SE 17TH ST
Practice Address - Street 2:600
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-4621
Practice Address - Country:US
Practice Address - Phone:352-732-8955
Practice Address - Fax:352-732-7999
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-13
Last Update Date:2020-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME30760208000000X
FLME00307602080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL036827000Medicaid