Healthcare Provider Details

I. General information

NPI: 1164549465
Provider Name (Legal Business Name): KERN DERMATOLOGY MEDICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2007
Last Update Date: 05/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2215 G ST
BAKERSFIELD CA
93301-3931
US

IV. Provider business mailing address

2215 G STREET
BAKERSFIELD CA
93301
US

V. Phone/Fax

Practice location:
  • Phone: 661-324-1312
  • Fax: 661-324-0901
Mailing address:
  • Phone: 661-324-1312
  • Fax: 661-324-0909

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberZZZ84406Z
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License NumberZZZ84406Z
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License NumberZZZ84406Z
License Number StateCA

VIII. Authorized Official

Name: MICHAEL A MACDUFF
Title or Position: PRESIDENT PHYSICIAN
Credential: MD
Phone: 661-324-1312