Provider Demographics
NPI:1386601938
Name:CHANDLER, KENNETH EUGENE (MD)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:EUGENE
Last Name:CHANDLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1029
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:AL
Mailing Address - Zip Code:35602-1029
Mailing Address - Country:US
Mailing Address - Phone:256-355-6414
Mailing Address - Fax:256-355-6646
Practice Address - Street 1:1405 7TH ST SE
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:AL
Practice Address - Zip Code:35601-3341
Practice Address - Country:US
Practice Address - Phone:256-355-6414
Practice Address - Fax:256-355-6646
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00007324208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1710290OtherUNITED HEALTH
AL1710290OtherUNITED HEALTH