Provider Demographics
NPI:1073515565
Name:KERNS, DAVID BRENT (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:BRENT
Last Name:KERNS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1040 S FLEISHEL AVE
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75701-2031
Mailing Address - Country:US
Mailing Address - Phone:903-533-8702
Mailing Address - Fax:903-533-8720
Practice Address - Street 1:1040 S FLEISHEL AVE
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-2031
Practice Address - Country:US
Practice Address - Phone:903-533-8702
Practice Address - Fax:903-533-8720
Is Sole Proprietor?:No
Enumeration Date:2005-08-15
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK0862208600000X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX770001111OtherRAILROAD MEDICARE
TXMDK0862OtherTEXAS WORKERS COMP / IHC
TX045355701Medicaid
TX3292271OtherBLUELINK
TX5849465OtherAETNA
TX86Z401OtherBCBS TX
TX045355701Medicaid
TX770001111OtherRAILROAD MEDICARE