Provider Demographics
NPI:1942321963
Name:KENNETH P PAGES MD PA
Entity Type:Organization
Organization Name:KENNETH P PAGES MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:PAGES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-878-2200
Mailing Address - Street 1:508 S HABANA AVE
Mailing Address - Street 2:SUITE 320
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33609-4181
Mailing Address - Country:US
Mailing Address - Phone:813-878-2200
Mailing Address - Fax:813-878-2069
Practice Address - Street 1:508 S HABANA AVE
Practice Address - Street 2:SUITE 320
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609-4181
Practice Address - Country:US
Practice Address - Phone:813-878-2200
Practice Address - Fax:813-878-2069
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2007-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME00761782084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1568494482OtherNPI
FLAD929OtherMEDICARE GROUP NUMBER