Dr. Charles Kennedy Jr., MD
Specialist in Fair Oak Ranch, TX. Individual provider (NPI-1).
NPI number1124455985
StatusActive
Last updated in NPPESOct 10, 2013
Details
- NPI
- 1124455985
- Entity type
- Individual (NPI-1)
- Name
- Dr. Charles Kennedy Jr.
- Credential
- MD
- Sex
- Male
- Sole proprietor
- Yes
- Enumeration date
- Oct 10, 2013
- Last updated
- Oct 10, 2013
Medicare and OIG
- Medicare enrolled (PECOS)
- Not in the Medicare enrollment file
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 174400000X | Specialist | MDE 2253 | TX | Yes |
Practice location
8454 Northview PassFair Oak Ranch, TX 78015
Phone 361-537-9671 · Fax 361-857-6974
Mailing address
8454 Northview PassFair Oak Ranch, TX 78015
Phone 361-537-9671 · Fax 361-857-6974
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