Individual
KENNETH PACANA BOC
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
5325 FARAON ST., ST. JOSEPH, MO 64506-3488
(816) 271-6406
(816) 271-7986
Mailing address
5325 FARAON ST., ST. JOSEPH, MO 64506-3488
(816) 271-6406
(816) 271-7986
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
2015032515
MO
207R00000X
Internal Medicine Physician
9406850
KS
208M00000X
Hospitalist Physician
Primary
2015032515
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1295933125
—
IA
05
—
1295933125
—
MO
05
—
200654820C
—
KS
01
—
P01573175
RR MEDICARE
MO
Enumeration date
07/03/2007
Last updated
03/31/2017
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