Individual
KEVIN LYNN KETCHERSIDE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CSFA
Contact information
Practice address
3697 S MARTINGALE RD, GILBERT, AZ 85297-7436
(480) 285-4990
(480) 659-4643
Mailing address
PO BOX 561, HIGLEY, AZ 85236-0561
(480) 285-4990
(480) 659-4643
Taxonomy
Speciality
Code
Description
License number
State
246ZC0007X
Surgical Assistant
Primary
130245
AZ
Other
Enumeration date
11/29/2011
Last updated
12/04/2012
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