Healthcare Provider Details

I. General information

NPI: 1972598480
Provider Name (Legal Business Name): PATRICK JAMES KEARNEY M.D., M.P.H.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 09/12/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 BODIN CIR
TRAVIS AFB CA
94535-1809
US

IV. Provider business mailing address

101 BODIN CIR
TRAVIS AFB CA
94535-1809
US

V. Phone/Fax

Practice location:
  • Phone: 707-423-3987
  • Fax: 707-423-5356
Mailing address:
  • Phone: 707-423-3987
  • Fax: 707-423-5356

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0011X
TaxonomyUndersea and Hyperbaric Medicine (Preventive Medicine) Physician
License NumberGFE71799
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: