Individual
KENNETH L DERRINGTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
156 MISSOURI BLVD STE B, GRAVOIS MILLS, MO 65037-5394
(573) 374-5263
(573) 374-4933
Mailing address
PO BOX 1519, LAURIE, MO 65038-1519
(573) 374-5800
(573) 374-5697
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
R9A11
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201366010
—
MO
01
—
R9A11
MO LICENSE
MO
Enumeration date
06/17/2005
Last updated
03/19/2018
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