Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | ME0059628 | FL |
NPI | 1154372100 |
---|---|
Provider Name | Susan F Kerns |
First Address | Ocala, FL 34471-4621 |
Second Address | Ocala, FL 34471-4621 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/05/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E90889 | (02) |