Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 036137808 | IL |
N | 208600000X | Surgeon | 036137808 | IL |
N | 208200000X | Surgeon | 46317 | AZ |
N | 208600000X | Surgeon | 46317 | AZ |
Y | 208200000X | Surgeon | C166068 | CA |
Y | 208600000X | Surgeon | C166068 | CA |
N | 2086S0102X | Surgical Critical Care | 46317 | AZ |
N | 2086S0127X | Trauma Surgeon | 46317 | AZ |
NPI | 1457570707 |
---|---|
Provider Name | Kari Jerge |
First Address | San Francisco, CA 94145-6432 |
Second Address | Scottsdale, AZ 85251-6432 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/04/2007 |
Last Update Date | 12/08/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
Z91719 | MEDICARE PTAN (01) | AZ |