Provider Demographics
NPI:1073526422
Name:MCVEY, KENNETH B (DO)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:B
Last Name:MCVEY
Suffix:
Gender:M
Credentials:DO
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 1618
Mailing Address - Street 2:
Mailing Address - City:POPLAR BLUFF
Mailing Address - State:MO
Mailing Address - Zip Code:63902-1618
Mailing Address - Country:US
Mailing Address - Phone:573-778-1336
Mailing Address - Fax:573-778-1336
Practice Address - Street 1:1720 KANELL BLVD
Practice Address - Street 2:SUITE 1
Practice Address - City:POPLAR BLUFF
Practice Address - State:MO
Practice Address - Zip Code:63901-4009
Practice Address - Country:US
Practice Address - Phone:573-778-1336
Practice Address - Fax:573-778-1336
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2013-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR4N692085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO507265502Medicaid
MO507265502Medicaid
MO001013973Medicare PIN