| Doctor Name: | KENNETH DEMASTERS |
| NPI Number: | 1073696605 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | |
| License Number: | PA1077 |
| Business Practice Address: | 507 Ne 12th St Moore, OK - 731605807 |
| Business Phone Number: | 4057034202 |
| Business Fax Number: | |
| Mailing Address: | 6805 N Woodbrook Rd, WARR ACRES |
| State: | OK |
| Postal Code: | 731326413 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 10/24/2006 |
| NPI Last Update Date: | 05/29/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AM0700X |
| License Number: | PA1077 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OK |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Medical |
| Taxonomy Definition: | |