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General NPI Number Information
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NPI Number | 1306948591
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Entity Type | Individual
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Provider Name | DEBORAH LEIGH KERN M.D.
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Gender | Female
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Dates
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Enumeration Date | 09/01/2006
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Last Update Date | 07/09/2018
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Provider Practice Location Address
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Address Line | 1000 ALPINE AVE SUITE #100
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City | BOULDER
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State | CO
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Zip | 80304-3406
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Country | US
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Telephone | 303-442-2150
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Fax | 303-442-3363
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Provider Business Mailing Address
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Address Line | PO BOX 26666 PHS PROVIDER ENROLLMENT
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City | ALBUQUERQUE
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State | NM
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Zip | 87125-6666
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Country | US
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Telephone | 505-923-6770
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Fax | 505-923-5354
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MD2008-0635
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License Number State | NM
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 37445
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License Number State | CO
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