Provider Demographics
NPI:1932127495
Name:KENTON, DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:
Last Name:KENTON
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 1:1874 W HILLSBORO BLVD
Mailing Address - Street 2:SUITE D
Mailing Address - City:DEERFIELD BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33442-1420
Mailing Address - Country:US
Mailing Address - Phone:954-428-4802
Mailing Address - Fax:954-428-5244
Practice Address - Street 1:1874 W HILLSBORO BLVD
Practice Address - Street 2:SUITE D
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33442-1420
Practice Address - Country:US
Practice Address - Phone:954-428-4802
Practice Address - Fax:954-428-5244
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0037023207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD27784Medicare UPIN