Provider Demographics
NPI:1619119401
Name:BETHEL, KEVIN PAUL (MD CM FAARM)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:PAUL
Last Name:BETHEL
Suffix:
Gender:M
Credentials:MD CM FAARM
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:10 CORAL ROAD
Mailing Address - Street 2:PO BOX F41325
Mailing Address - City:FREEPORT
Mailing Address - State:GRAND BAHAMA
Mailing Address - Zip Code:33023
Mailing Address - Country:BS
Mailing Address - Phone:242-374-5424
Mailing Address - Fax:242-374-4822
Practice Address - Street 1:7949 FAIRWAY BLVD
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33023-6417
Practice Address - Country:US
Practice Address - Phone:305-454-1768
Practice Address - Fax:242-374-4822
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-25
Last Update Date:2009-03-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLBMC1019207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine