Provider Demographics
NPI:1730240243
Name:KEUHN, JERRY A (DO)
Entity type:Individual
Prefix:
First Name:JERRY
Middle Name:A
Last Name:KEUHN
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 1:191 IOWA BLVD
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:MO
Mailing Address - Zip Code:64683-8343
Mailing Address - Country:US
Mailing Address - Phone:660-358-5700
Mailing Address - Fax:660-358-5740
Practice Address - Street 1:191 IOWA BLVD
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:MO
Practice Address - Zip Code:64683-8343
Practice Address - Country:US
Practice Address - Phone:660-358-5700
Practice Address - Fax:660-358-5740
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2011-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR7835207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1730240243OtherNPI
MO1730240243OtherNPI