Provider Demographics
NPI:1053533760
Name:KEPFER, PERCY D (MD)
Entity type:Individual
Prefix:DR
First Name:PERCY
Middle Name:D
Last Name:KEPFER
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 1:4018 GREENWOOD DR
Mailing Address - Street 2:
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34982-6151
Mailing Address - Country:US
Mailing Address - Phone:772-464-2607
Mailing Address - Fax:772-464-4525
Practice Address - Street 1:4018 GREENWOOD DR
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34982-6151
Practice Address - Country:US
Practice Address - Phone:772-464-2607
Practice Address - Fax:772-464-4525
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2014-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0022120207Q00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD85743Medicare UPIN