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General NPI Number Information
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NPI Number | 1962646414
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Entity Type | Individual
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Provider Name | KENNETH S. PHERSON D.O.
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Gender | Male
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Dates
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Enumeration Date | 04/28/2009
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Last Update Date | 02/08/2019
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Provider Practice Location Address
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Address Line | 11234 RIVERS BLUFF CIR
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City | LAKEWOOD RANCH
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State | FL
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Zip | 34202-1846
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Country | US
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Telephone | 765-243-3365
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Fax | 765-243-3365
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Provider Business Mailing Address
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Address Line | 11234 RIVERS BLUFF CIR
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City | LAKEWOOD RANCH
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State | FL
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Zip | 34202-1846
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Country | US
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Telephone | 765-243-3365
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Fax | 765-243-3365
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | OS15613
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 02003531A
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License Number State | IN
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Taxonomy #3
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 5101018853
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License Number State | MI
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