Provider Demographics
NPI:1417061920
Name:SPANGLER, KENNETH A (DO)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:A
Last Name:SPANGLER
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 1:500 PORTER AVE
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:MO
Mailing Address - Zip Code:65605-2365
Mailing Address - Country:US
Mailing Address - Phone:417-678-7855
Mailing Address - Fax:
Practice Address - Street 1:500 PORTER AVE
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:MO
Practice Address - Zip Code:65605
Practice Address - Country:US
Practice Address - Phone:417-678-7855
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2018-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR6D66207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO242117315Medicaid
440050041Medicare PIN
F20825Medicare UPIN
MO152360529Medicare PIN