MEDICARE: JOHN P KEARNEY M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician	G26058	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1144254764
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN P KEARNEY M.D.

Provider Business Mailing Address
First Line	:	355 E 21ST ST STE C
Second Line	:
City	:	SAN BERNARDINO
State	:	CA
Zip	:	92404-4851
Country	:	US
Telephone Number	:	909-883-6811
Fax Number	:	909-883-2494

Provider Business Practice Location Address
First Line	:	355 E 21ST ST STE C
Second Line	:
City	:	SAN BERNARDINO
State	:	CA
Zip	:	92404-4851
Country	:	US
Telephone Number	:	909-883-6811
Fax Number	:	909-883-2494

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/10/2006
Last Update Date	:	12/04/2018

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Directions to “ JOHN P KEARNEY M.D.” Practice Location

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