Provider Demographics
NPI:1962646414
Name:PHERSON, KENNETH S (DO)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:S
Last Name:PHERSON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:11234 RIVERS BLUFF CIR
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD RANCH
Mailing Address - State:FL
Mailing Address - Zip Code:34202-1846
Mailing Address - Country:US
Mailing Address - Phone:765-243-3365
Mailing Address - Fax:765-243-3365
Practice Address - Street 1:11234 RIVERS BLUFF CIR
Practice Address - Street 2:
Practice Address - City:LAKEWOOD RANCH
Practice Address - State:FL
Practice Address - Zip Code:34202-1846
Practice Address - Country:US
Practice Address - Phone:765-243-3365
Practice Address - Fax:765-243-3365
Is Sole Proprietor?:No
Enumeration Date:2009-04-28
Last Update Date:2019-02-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLOS15613207X00000X
IN02003531A207X00000X
MI5101018853207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery