Provider Demographics
NPI:1316103823
Name:OULDS, KEVIN P (DPM)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:P
Last Name:OULDS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:DR
Other - First Name:KEVIN
Other - Middle Name:P
Other - Last Name:OULDS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DPM
Mailing Address - Street 1:991 ROLLINGWOOD LOOP
Mailing Address - Street 2:APT 115
Mailing Address - City:CASSELBERRY
Mailing Address - State:FL
Mailing Address - Zip Code:32707-5819
Mailing Address - Country:US
Mailing Address - Phone:407-508-6456
Mailing Address - Fax:
Practice Address - Street 1:991 ROLLINGWOOD LOOP
Practice Address - Street 2:APT 115
Practice Address - City:CASSELBERRY
Practice Address - State:FL
Practice Address - Zip Code:32707-5819
Practice Address - Country:US
Practice Address - Phone:407-508-6456
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-04
Last Update Date:2020-09-28
Deactivation Date:2018-12-20
Deactivation Code:
Reactivation Date:2019-01-22
Provider Licenses
StateLicense IDTaxonomies
FLPO3430213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL6500900Medicaid
FL6500900Medicaid
FLDE893WMedicare PIN