Provider Demographics
NPI:1801905039
Name:KREIFELS, MARCENE FAYE (MD)
Entity type:Individual
Prefix:DR
First Name:MARCENE
Middle Name:FAYE
Last Name:KREIFELS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1198 S FERDON BLVD
Mailing Address - Street 2:
Mailing Address - City:CRESTVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:32536-4512
Mailing Address - Country:US
Mailing Address - Phone:850-682-1735
Mailing Address - Fax:850-689-4400
Practice Address - Street 1:1198 S FERDON BLVD
Practice Address - Street 2:
Practice Address - City:CRESTVIEW
Practice Address - State:FL
Practice Address - Zip Code:32536-4512
Practice Address - Country:US
Practice Address - Phone:850-682-1735
Practice Address - Fax:850-689-4400
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL50036207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL045005700Medicaid
230000426OtherRRB PTAN
FL02644WMedicare PIN
FL02644XMedicare PIN
230000426OtherRRB PTAN