Provider Demographics
NPI:1144232778
Name:KEARSE, WILFRED S JR (MD)
Entity Type:Individual
Prefix:
First Name:WILFRED
Middle Name:S
Last Name:KEARSE
Suffix:JR
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:PO BOX 33865
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92163-3865
Mailing Address - Country:US
Mailing Address - Phone:858-888-7700
Mailing Address - Fax:
Practice Address - Street 1:8851 CENTER DR STE 501
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-3033
Practice Address - Country:US
Practice Address - Phone:619-697-2456
Practice Address - Fax:858-429-7930
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2020-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG83318208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G833180Medicaid
CACB307684OtherMEDICARE ID
CA00G833180Medicaid