Healthcare Provider Details

I. General information

NPI: 1417968173
Provider Name (Legal Business Name): DOUGLAS P KERR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 05/21/2020
Certification Date: 05/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2021 HERNDON AVE # 101
CLOVIS CA
93611-6101
US

IV. Provider business mailing address

2021 HERNDON AVE STE 101
CLOVIS CA
93611-6316
US

V. Phone/Fax

Practice location:
  • Phone: 559-981-5566
  • Fax: 559-321-8730
Mailing address:
  • Phone: 559-797-4315
  • Fax: 559-321-8730

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberG69670
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: