MEDICARE: DR. JOHN B KERNAN 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	173000000X	Legal Medicine	78-47	NM
2	207R00000X	Internal Medicine Physician	78-47	NM

General Provider Information

NPI Number	:	1255412839
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN B KERNAN M.D.

Provider Business Mailing Address
First Line	:	5419 N LOVINGTON HWY STE 13
Second Line	:
City	:	HOBBS
State	:	NM
Zip	:	88240-9135
Country	:	US
Telephone Number	:	505-392-7798
Fax Number	:	505-392-4926

Provider Business Practice Location Address
First Line	:	5419 N LOVINGTON HWY STE 13
Second Line	:
City	:	HOBBS
State	:	NM
Zip	:	88240-9135
Country	:	US
Telephone Number	:	505-392-7798
Fax Number	:	505-392-4926

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

Provider Enumeration Date	:	10/18/2006
Last Update Date	:	04/12/2018

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