Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207KA0200X | Allergist | MD18405 | OR |
NPI | 1568465847 |
---|---|
Provider Name | Dr. Edward Kerwin |
First Address | Medford, OR 97504-9741 |
Second Address | Medford, OR 97504-9741 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/05/2005 |
Last Update Date | 10/07/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
056700 | (05) | OR |
E54967 | (02) | OR |