Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QG0300X | Family Doctor - Geriatric Medicine | 4301064515 | MI |
NPI | 1184695868 |
---|---|
Provider Name | Dr. William Archibald Kerr |
First Address | Gaylord, MI 49735-1682 |
Second Address | Gaylord, MI 49735-1682 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/01/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0806907210 | BCBS (01) | |
F88857 | (02) |