Healthcare Provider Details

I. General information

NPI: 1881697696
Provider Name (Legal Business Name): ROBERT A. KERLAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2005
Last Update Date: 11/19/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6005 PARK AVE STE 200
MEMPHIS TN
38119-5212
US

IV. Provider business mailing address

6005 PARK AVE STE 200
MEMPHIS TN
38119-5212
US

V. Phone/Fax

Practice location:
  • Phone: 901-761-2100
  • Fax: 901-682-9351
Mailing address:
  • Phone: 901-761-2100
  • Fax: 901-682-9351

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberMD006515
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: