Provider Demographics
NPI:1063704161
Name:LAMBERT, KENNETH CHAD (DO)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:CHAD
Last Name:LAMBERT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3202 MILLER ST
Mailing Address - Street 2:
Mailing Address - City:BETHANY
Mailing Address - State:MO
Mailing Address - Zip Code:64424-2713
Mailing Address - Country:US
Mailing Address - Phone:660-425-3154
Mailing Address - Fax:660-425-6663
Practice Address - Street 1:3202 MILLER ST
Practice Address - Street 2:
Practice Address - City:BETHANY
Practice Address - State:MO
Practice Address - Zip Code:64424-2713
Practice Address - Country:US
Practice Address - Phone:660-425-3154
Practice Address - Fax:660-425-6663
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-07
Last Update Date:2019-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011011360207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine