Individual
DR. KENDALL WAYNE SOUTHERN
Active
Individual
DR. KENDALL WAYNE SOUTHERN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O., D.PH.
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
9440
OK
207Q00000X
Family Medicine Physician
2333
OK
2084P0800X
Psychiatry Physician
Primary
2333
OK
2084P0800X
Psychiatry Physician
48464
GA
2084P0800X
Psychiatry Physician
5101009836
MI
2084P0800X
Psychiatry Physician
DO-641
AL
2084P0800X
Psychiatry Physician
H9426
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100124360A
—
OK
Enumeration date
12/12/2006
Last updated
10/17/2011
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