Provider Demographics
NPI:1871797076
Name:KENNEDY, L. JAMES JR (MD)
Entity type:Individual
Prefix:DR
First Name:L.
Middle Name:JAMES
Last Name:KENNEDY
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 PINON RD E
Mailing Address - Street 2:
Mailing Address - City:RIDGWAY
Mailing Address - State:CO
Mailing Address - Zip Code:81432-8934
Mailing Address - Country:US
Mailing Address - Phone:970-626-3990
Mailing Address - Fax:
Practice Address - Street 1:304 PINON RD E
Practice Address - Street 2:
Practice Address - City:RIDGWAY
Practice Address - State:CO
Practice Address - Zip Code:81432-8934
Practice Address - Country:US
Practice Address - Phone:970-626-3990
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO19428207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology