Provider Demographics
NPI:1598863904
Name:EDEN, KENNETH VERNON (MD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:VERNON
Last Name:EDEN
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:P.O. BOX 6369
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59604
Mailing Address - Country:US
Mailing Address - Phone:406-447-2828
Mailing Address - Fax:406-447-2825
Practice Address - Street 1:2525 BROADWAY
Practice Address - Street 2:SUITE 200
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59601
Practice Address - Country:US
Practice Address - Phone:406-457-4343
Practice Address - Fax:406-457-4344
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT3711207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0142477Medicaid
MT16771OtherBCBS OF MT
MT16771OtherBCBS OF MT