Provider Demographics
NPI:1528156080
Name:DUGAN, KENNETH H (MD)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:H
Last Name:DUGAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 108
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65704-0108
Mailing Address - Country:US
Mailing Address - Phone:417-924-3066
Mailing Address - Fax:417-924-3925
Practice Address - Street 1:304 W. COMMERCIAL
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:MO
Practice Address - Zip Code:65704
Practice Address - Country:US
Practice Address - Phone:417-924-3066
Practice Address - Fax:417-924-3925
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO113801207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOE68252Medicare UPIN