MEDICARE: DR. JACK DAVID KERNS IX 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	2083X0100X	Occupational Medicine Physician	154452	NY

General Provider Information

NPI Number	:	1285855932
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JACK DAVID KERNS IX M.D.

Provider Business Mailing Address
First Line	:	204 SEMMEL ROAD
Second Line	:
City	:	HONEOYE FALLS
State	:	NY
Zip	:	14472
Country	:	US
Telephone Number	:	585-734-0906
Fax Number	:

Provider Business Practice Location Address
First Line	:	204 SEMMEL RD
Second Line	:
City	:	HONEOYE FALLS
State	:	NY
Zip	:	14472-9756
Country	:	US
Telephone Number	:	585-734-0906
Fax Number	:

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

Provider Enumeration Date	:	05/01/2007
Last Update Date	:	07/08/2007

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