Individual
KEVIN BOATRIGHT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
301 N WASHINGTON ST, SUITE 5, FARMINGTON, MO 63640-1751
(573) 756-1744
(573) 756-2499
Mailing address
670 MASON RIDGE CENTER DR, SUITE 300, SAINT LOUIS, MO 63141-8573
(573) 756-1744
(573) 756-2499
Taxonomy
Speciality
Code
Description
License number
State
207K00000X
Allergy & Immunology Physician
Primary
R7D62
MO
207Q00000X
Family Medicine Physician
R7D62
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201971702
—
MO
Enumeration date
08/23/2006
Last updated
11/13/2012
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