Provider Demographics
NPI:1326099136
Name:UBBEN, KENNETH L (MD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:L
Last Name:UBBEN
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 1:5 CUNNINGHAM COR
Mailing Address - Street 2:
Mailing Address - City:BELLA VISTA
Mailing Address - State:AR
Mailing Address - Zip Code:72714-3520
Mailing Address - Country:US
Mailing Address - Phone:479-855-1247
Mailing Address - Fax:479-855-1249
Practice Address - Street 1:5 CUNNINGHAM COR
Practice Address - Street 2:
Practice Address - City:BELLA VISTA
Practice Address - State:AR
Practice Address - Zip Code:72714-3520
Practice Address - Country:US
Practice Address - Phone:479-855-1247
Practice Address - Fax:479-855-1249
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC-8212174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR122172001Medicaid
AR55539Medicare ID - Type Unspecified
AR122172001Medicaid