Healthcare Provider Details

I. General information

NPI: 1073507315
Provider Name (Legal Business Name): KENNETT D ASHER JR. D. O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2005
Last Update Date: 08/09/2023
Certification Date: 08/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

612 HWY 25 SOUTH
BLOOMFIELD MO
63825-9566
US

IV. Provider business mailing address

612 HWY 25 SOUTH
BLOOMFIELD MO
63825-9566
US

V. Phone/Fax

Practice location:
  • Phone: 573-568-7377
  • Fax: 573-568-7320
Mailing address:
  • Phone: 573-568-7377
  • Fax: 573-568-7320

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberR6947
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: