Provider Demographics
NPI:1396743001
Name:KENDRA, JOSEPH C (MD)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:C
Last Name:KENDRA
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 1:2525 US HIGHWAY 431 STE 40
Mailing Address - Street 2:
Mailing Address - City:BOAZ
Mailing Address - State:AL
Mailing Address - Zip Code:35957-5964
Mailing Address - Country:US
Mailing Address - Phone:256-840-4846
Mailing Address - Fax:256-840-4847
Practice Address - Street 1:2525 US HIGHWAY 431 STE 40
Practice Address - Street 2:
Practice Address - City:BOAZ
Practice Address - State:AL
Practice Address - Zip Code:35957-5964
Practice Address - Country:US
Practice Address - Phone:256-840-4846
Practice Address - Fax:256-840-4847
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-07
Last Update Date:2020-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL15295207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51027724OtherBLUE CROSS AND BLUE SHIEL
AL000027724Medicaid
AL000027724Medicare ID - Type Unspecified
AL51027724OtherBLUE CROSS AND BLUE SHIEL