Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | 34004653 | OH |
N | 207Q00000X | Family Doctor | 34004653 | OH |
N | 207RA0401X | Internist - Addiction Medicine | 34004653 | OH |
N | 208D00000X | General Practice Physician | 34004653 | OH |
NPI | 1760598965 |
---|---|
Provider Name | John Kerns |
First Address | Jacksonville, FL 32211-8768 |
Second Address | Willard, OH 44890-1611 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/08/2006 |
Last Update Date | 19/07/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F01816 | (02) | OH |