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General NPI Number Information
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NPI Number | 1144278607
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Entity Type | Organization
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Legal Business Name | KENNETH A DECOURSEY, MD PC
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Dates
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Enumeration Date | 05/05/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1723 BROADWAY ST SUITE 120
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City | CAPE GIRARDEAU
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State | MO
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Zip | 63701-4505
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Country | US
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Telephone | 573-334-7194
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Fax | 573-334-4937
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Provider Business Mailing Address
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Address Line | 5311 LEXINGTON ST
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City | JACKSON
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State | MO
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Zip | 63755-3825
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | KENNETH A DECOURSEY
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Credential | M.D.
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Telephone | 573-334-7194
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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