Provider Demographics
NPI:1205891850
Name:KENT, CHARLES (MD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:
Last Name:KENT
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 1:3301 THOMASVILLE RD
Mailing Address - Street 2:STE 102
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-7946
Mailing Address - Country:US
Mailing Address - Phone:850-391-9622
Mailing Address - Fax:850-576-8346
Practice Address - Street 1:3301 THOMASVILLE RD
Practice Address - Street 2:STE 102
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-7946
Practice Address - Country:US
Practice Address - Phone:850-391-9622
Practice Address - Fax:850-576-8346
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-18
Last Update Date:2014-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME40570207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL067125800Medicaid
FL20053WMedicare ID - Type UnspecifiedMEDICARE NUMBER
FL067125800Medicaid