MEDICARE: DR. JOHN PATRICK KEGERREIS PH.D.

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	103TC0700X	Clinical Psychologist	22780	TX

General Provider Information

NPI Number	:	1487633202
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN PATRICK KEGERREIS PH.D.

Provider Business Mailing Address
First Line	:	201B W MOORE AVE
Second Line	:
City	:	TERRELL
State	:	TX
Zip	:	75160-3115
Country	:	US
Telephone Number	:	972-563-1981
Fax Number	:	972-563-2537

Provider Business Practice Location Address
First Line	:	201B W MOORE AVE
Second Line	:
City	:	TERRELL
State	:	TX
Zip	:	75160-3115
Country	:	US
Telephone Number	:	972-563-1981
Fax Number	:	972-563-2537

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

Provider Enumeration Date	:	01/10/2006
Last Update Date	:	07/08/2007

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