Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 37405 | WI |
N | 111NI0900X | Internist | 37405 | WI |
Y | 207RA0401X | Internist - Addiction Medicine | 37405 | WI |
NPI | 1609872910 |
---|---|
Provider Name | Bruce J Kerr |
First Address | La Crosse, WI 54601-5429 |
Second Address | La Crosse, WI 54601-5429 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2005 |
Last Update Date | 18/01/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
32224800 | (05) | WI |
A77431 | (02) |