Individual
KEN J. CARPENTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3555 S NATIONAL AVE, SPRINGFIELD, MO 65807-7310
(417) 875-3800
(417) 875-3177
Mailing address
PO BOX 9007, SPRINGFIELD, MO 65808-9007
(417) 875-3000
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
46072-020
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2012011928
MO LICENSE
MO
05
—
204188700
—
MO
Enumeration date
05/07/2007
Last updated
12/27/2018
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