Active NPI
Robert G Kettrick, MD
- Anesthesiology Physician
- Jacksonville, FL
National Provider Identifier
1891821617
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Anesthesiology Physician
- License
- ME72828
- Practice address
- 4600 Touchton Rd E
Suite 2500
Jacksonville, FL 32246-8299 - Phone
- (904) 232-4262
- Fax
- (904) 232-4230
- NPI assigned
- Feb 26, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Anesthesiology Physician | 207L00000X | ME72828 | FL | Primary |
| Anesthesiology Physician | 207L00000X | C10002939 | DE |
Addresses
Primary practice location
4600 Touchton Rd E
Suite 2500
Jacksonville, FL 32246-8299
Mailing address
Corporate Credentialing
P.O. Box 269
Wilmington, DE 19899
Phone (302) 651-5938
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| C10002939 | DE | MD | Anesthesiology Physician |
| ME72828 | FL | MD | Anesthesiology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1172448000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1891821617",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "CORPORATE CREDENTIALING",
"address_2": "P.O. BOX 269",
"city": "WILMINGTON",
"state": "DE",
"postal_code": "19899",
"telephone_number": "302-651-5938",
"fax_number": "302-651-6077"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4600 TOUCHTON RD E",
"address_2": "SUITE 2500",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "322468299",
"telephone_number": "904-232-4262",
"fax_number": "904-232-4230"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KETTRICK",
"first_name": "ROBERT",
"middle_name": "G",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-02-26",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "207L00000X",
"taxonomy_group": "",
"desc": "Anesthesiology",
"state": "FL",
"license": "ME72828",
"primary": true
},
{
"code": "207L00000X",
"taxonomy_group": "",
"desc": "Anesthesiology",
"state": "DE",
"license": "C10002939",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Jacksonville, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.