Healthcare Provider Details

I. General information

NPI: 1962460238
Provider Name (Legal Business Name): KENT L ADKINS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 06/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12855 N 40 DR SUITE 230
SAINT LOUIS MO
63141-8657
US

IV. Provider business mailing address

PO BOX 23340
SAINT LOUIS MO
63156-3340
US

V. Phone/Fax

Practice location:
  • Phone: 314-576-3532
  • Fax: 314-878-5548
Mailing address:
  • Phone: 314-576-3532
  • Fax: 314-878-5548

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number2003026270
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: