MEDICARE: KENNETT D ASHER JR. D. O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	R6947	MO

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	080030087	OTHER	MO	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	178227	OTHER	MO	HEALTHLINK
4	697138	OTHER	MO	ANTHEM BCBS

General Provider Information

NPI Number	:	1073507315
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENNETT D ASHER JR. D. O.

Provider Business Mailing Address
First Line	:	612 HWY 25 SOUTH
Second Line	:
City	:	BLOOMFIELD
State	:	MO
Zip	:	63825-9566
Country	:	US
Telephone Number	:	573-568-7377
Fax Number	:	573-568-7320

Provider Business Practice Location Address
First Line	:	612 HWY 25 SOUTH
Second Line	:
City	:	BLOOMFIELD
State	:	MO
Zip	:	63825-9566
Country	:	US
Telephone Number	:	573-568-7377
Fax Number	:	573-568-7320

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/01/2005
Last Update Date	:	08/09/2023

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