Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 6185 | NV |
Y | 213EG0000X | General Practice | 6185 | NV |
NPI | 1003199399 |
---|---|
Provider Name | Dr. Douglas K Kern |
First Address | Henderson, NV 89014-0401 |
Second Address | Henderson, NV 89014-0401 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/09/2011 |
Last Update Date | 26/02/2015 |