Individual
DR. KENNETH A DECOURSEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1723 BROADWAY, SUITE 120, CAPE GIRARDEAU, MO 63701
(573) 334-7194
(573) 334-4937
Mailing address
5311 LEXINGTON ST, JACKSON, MO 63755-3825
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
102354
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0106771
UNITED HEALTHCARE
—
01
—
131268
BLUE CROSS BLUE SHIELD
MO
01
—
180360
BLUE CROSS BLUE SHIELD
MO
01
—
649138
HEALTHLINK
—
01
—
DA3724
RAILROAD MEDICARE ID
—
01
—
P00056880
RAILROAD MEDICARE ID
—
Enumeration date
03/12/2007
Last updated
07/09/2007
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