Provider Demographics
NPI:1922040807
Name:WHIPPLE, KENNETH JOHN (DO)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:JOHN
Last Name:WHIPPLE
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 1:401 15TH AVE S STE 109
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59405-4334
Mailing Address - Country:US
Mailing Address - Phone:406-727-6311
Mailing Address - Fax:406-727-1070
Practice Address - Street 1:401 15TH AVE S STE 109
Practice Address - Street 2:
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59405-4334
Practice Address - Country:US
Practice Address - Phone:406-727-6311
Practice Address - Fax:406-727-1070
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2011-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA3692207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology