Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 5356 | AZ |
NPI | 1144392515 |
---|---|
Provider Name | Dr. Mark A Kerr |
First Address | Higley, AZ 85236 |
Second Address | Higley, AZ 85236 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/11/2006 |
Last Update Date | 08/07/2007 |