Provider Demographics
NPI:1679769723
Name:CULLEN, KEVIN EDWARD (DO)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:EDWARD
Last Name:CULLEN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:401 PALMETTO ST
Mailing Address - Street 2:
Mailing Address - City:NEW SMYRNA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32168-7322
Mailing Address - Country:US
Mailing Address - Phone:386-424-3843
Mailing Address - Fax:386-424-3844
Practice Address - Street 1:512 VICTORIA LN
Practice Address - Street 2:SUITE 12
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78550-3226
Practice Address - Country:US
Practice Address - Phone:956-443-6300
Practice Address - Fax:888-730-1925
Is Sole Proprietor?:No
Enumeration Date:2007-09-22
Last Update Date:2015-07-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAOS013492207R00000X
SCTL1118208M00000X
FLOS13322208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLID470ZMedicare PIN