Individual
KENNETH DEAN PHILLIPS JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
8 DOCTORS PARK, CAPE GIRARDEAU, MO 63703-4928
(573) 651-1333
(573) 651-1324
Mailing address
8 DOCTORS PARK, CAPE GIRARDEAU, MO 63703-4928
(573) 651-1333
(573) 651-1324
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
106690
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
207656638
—
MO
Enumeration date
02/02/2006
Last updated
03/29/2021
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