Provider Demographics
NPI:1265540777
Name:JAIN, DAVE K (DO)
Entity type:Individual
Prefix:DR
First Name:DAVE
Middle Name:K
Last Name:JAIN
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 1:201 FLOYD ST
Mailing Address - Street 2:
Mailing Address - City:KENNETT
Mailing Address - State:MO
Mailing Address - Zip Code:63857-2450
Mailing Address - Country:US
Mailing Address - Phone:573-888-4226
Mailing Address - Fax:573-888-4221
Practice Address - Street 1:201 FLOYD ST
Practice Address - Street 2:
Practice Address - City:KENNETT
Practice Address - State:MO
Practice Address - Zip Code:63857-2450
Practice Address - Country:US
Practice Address - Phone:573-888-4226
Practice Address - Fax:573-888-4221
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-25
Last Update Date:2021-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-0373207R00000X
MOR1K93207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO242974426Medicaid
MO242974426Medicaid
MOE36367Medicare UPIN