Individual
KENNETH DOLEN JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
930 CARONDELET DR, SUITE 104, KANSAS CITY, MO 64114-4855
(816) 941-2222
(816) 941-2282
Mailing address
930 CARONDELET DR 201, KANSAS CITY, MO 64114-4698
(816) 941-2222
(816) 941-2282
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
9406666
KS
208600000X
Surgery Physician
Primary
2008033152
MO
Other
Enumeration date
12/19/2006
Last updated
10/15/2015
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