Healthcare Provider Details

I. General information

NPI: 1497745525
Provider Name (Legal Business Name): DAVID JOHN KERSBERGEN D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/28/2005
Last Update Date: 01/14/2025
Certification Date: 01/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2817 ROCK MERRITT AVE
FORT LIBERTY NC
28310-0001
US

IV. Provider business mailing address

2817 ROCK MERRITT AVE
FORT LIBERTY NC
28310-0001
US

V. Phone/Fax

Practice location:
  • Phone: 910-907-8500
  • Fax: 910-907-9630
Mailing address:
  • Phone: 910-907-8500
  • Fax: 910-907-9630

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0102050143
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number04583
License Number StateIA
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2017-00394
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: