Provider Demographics
NPI:1083693683
Name:KERKEMEYER, GEORGE P (MD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:P
Last Name:KERKEMEYER
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 1:100 MEDICAL DR
Mailing Address - Street 2:P.O. BOX 311
Mailing Address - City:HANNIBAL
Mailing Address - State:MO
Mailing Address - Zip Code:63401-6877
Mailing Address - Country:US
Mailing Address - Phone:573-231-3783
Mailing Address - Fax:573-231-3784
Practice Address - Street 1:100 MEDICAL DR
Practice Address - Street 2:
Practice Address - City:HANNIBAL
Practice Address - State:MO
Practice Address - Zip Code:63401-6877
Practice Address - Country:US
Practice Address - Phone:573-231-3783
Practice Address - Fax:573-231-3784
Is Sole Proprietor?:No
Enumeration Date:2006-01-11
Last Update Date:2014-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR6A59207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO201726015Medicaid
MO927303772Medicare ID - Type Unspecified
A11113Medicare UPIN