Basic Information
| Provider Information | |||||||||
| NPI: | 1124162979 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | STRINGER | ||||||||
| FirstName: | KENTON | ||||||||
| MiddleName: | L. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 500 PORTER AVE | ||||||||
| Address2: | |||||||||
| City: | AURORA | ||||||||
| State: | MO | ||||||||
| PostalCode: | 656052365 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4176787888 | ||||||||
| FaxNumber: | 4176787858 | ||||||||
| Practice Location | |||||||||
| Address1: | 500 PORTER AVE | ||||||||
| Address2: | |||||||||
| City: | AURORA | ||||||||
| State: | MO | ||||||||
| PostalCode: | 656052365 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4176787888 | ||||||||
| FaxNumber: | 4176787858 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/16/2007 | ||||||||
| LastUpdateDate: | 02/18/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | R6B17 | MO | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 201809423 | 05 | MO | MEDICAID | 99307 | 01 | MO | AR BLUE SHIELD # | OTHER |