MEDICARE: ROBERT E KEARNEY MD INC

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	174400000X	Specialist	G87026	CA

General Provider Information

NPI Number	:	1871605733
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROBERT E KEARNEY MD INC

Provider Business Mailing Address
First Line	:	4520 EXECUTIVE DRIVE,
Second Line	:	SUITE 150
City	:	SAN DIEGO
State	:	CA
Zip	:	92191
Country	:	US
Telephone Number	:	858-677-9352
Fax Number	:

Provider Business Practice Location Address
First Line	:	4520 EXECUTIVE DR
Second Line	:	SUITE 150
City	:	SAN DIEGO
State	:	CA
Zip	:	92121-3018
Country	:	US
Telephone Number	:	858-677-9352
Fax Number	:	858-677-9356

Authorized Official
Title or Position	:	OWNER
Name	:	DR. ROBERT E KEARNEY
Credential	:	M.D.
Telephone Number	:	858-677-9352

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	07/01/2011

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