Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 53368 | AZ |
N | 207Q00000X | Family Doctor | G40948 | CA |
N | 207QA0505X | Family Doctor - Adult Medicine | 29082 | NE |
N | 207QA0505X | Family Doctor - Adult Medicine | 8956 | SD |
NPI | 1104999572 |
---|---|
Provider Name | Dr. Colin P Kerr |
First Address | Prescott, AZ 86305-3700 |
Second Address | Prescott, AZ 86305-3700 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/11/2006 |
Last Update Date | 31/01/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02143451 | (05) | CA |
225558 | (05) | AZ |
C84908 | (02) | CA |