Provider Demographics
NPI:1710914932
Name:KENOYER, MARSHALL RAY (MD)
Entity Type:Individual
Prefix:DR
First Name:MARSHALL
Middle Name:RAY
Last Name:KENOYER
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:PO BOX 743
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:KS
Mailing Address - Zip Code:67878-0743
Mailing Address - Country:US
Mailing Address - Phone:620-384-7350
Mailing Address - Fax:620-384-7370
Practice Address - Street 1:700 NORTH HUSER
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:KS
Practice Address - Zip Code:67878-1278
Practice Address - Country:US
Practice Address - Phone:620-384-7350
Practice Address - Fax:620-384-7370
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-14725208600000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered208600000XAllopathic & Osteopathic PhysiciansSurgery
Not Answered208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSD09128Medicare UPIN
KS103272Medicare ID - Type Unspecified