Provider Demographics
NPI:1073507315
Name:ASHER, KENNETT D JR (D O)
Entity Type:Individual
Prefix:
First Name:KENNETT
Middle Name:D
Last Name:ASHER
Suffix:JR
Gender:M
Credentials:D O
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:612 HWY 25 SOUTH
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63825-9566
Mailing Address - Country:US
Mailing Address - Phone:573-568-7377
Mailing Address - Fax:573-568-7320
Practice Address - Street 1:612 HWY 25 SOUTH
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:MO
Practice Address - Zip Code:63825-9566
Practice Address - Country:US
Practice Address - Phone:573-568-7377
Practice Address - Fax:573-568-7320
Is Sole Proprietor?:No
Enumeration Date:2005-09-01
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR6947207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO240303008Medicaid
MO080030087OtherRR MEDICARE
MO178227OtherHEALTHLINK
MO697138OtherANTHEM BCBS
MO240303008Medicaid
MO001013269Medicare PIN