MEDICARE: DR. ROBERT E KEARNEY MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2086S0122X	Plastic and Reconstructive Surgery Physician	687026	CA

General Provider Information

NPI Number	:	1174537559
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT E KEARNEY MD

Provider Business Mailing Address
First Line	:	4520 EXECUTIVE DR
Second Line	:	#150
City	:	SAN DIEGO
State	:	CA
Zip	:	92121-3018
Country	:	US
Telephone Number	:	858-677-9352
Fax Number	:	858-677-9356

Provider Business Practice Location Address
First Line	:	4520 EXECUTIVE DR
Second Line	:	#150
City	:	SAN DIEGO
State	:	CA
Zip	:	92121-3018
Country	:	US
Telephone Number	:	858-677-9352
Fax Number	:	858-677-9356

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/28/2006
Last Update Date	:	02/08/2011

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