MEDICARE: FRED KERSH DO PA

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	2083X0100X	Occupational Medicine Physician

General Provider Information

NPI Number	:	1851499750
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FRED KERSH DO PA

Provider Business Mailing Address
First Line	:	PO BOX 130757
Second Line	:
City	:	TYLER
State	:	TX
Zip	:	75713-0757
Country	:	US
Telephone Number	:	903-593-9999
Fax Number	:	903-526-4239

Provider Business Practice Location Address
First Line	:	906 E FRONT ST
Second Line	:
City	:	TYLER
State	:	TX
Zip	:	75702-8328
Country	:	US
Telephone Number	:	903-593-9999
Fax Number	:	903-526-4239

Authorized Official
Title or Position	:	OWNER
Name	:	DR. FRED W KERSH
Credential	:	DO
Telephone Number	:	903-593-9999

Provider Enumeration Date	:	09/21/2006
Last Update Date	:	10/01/2007

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Directions to “FRED KERSH DO PA ” Practice Location

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