Provider Demographics
NPI:1164459186
Name:KERGER, SHAWN R (DO)
Entity Type:Individual
Prefix:
First Name:SHAWN
Middle Name:R
Last Name:KERGER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5350 FRANTZ RD
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43016-4259
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2030 STRINGTOWN RD FL 3
Practice Address - Street 2:
Practice Address - City:GROVE CITY
Practice Address - State:OH
Practice Address - Zip Code:43123-3993
Practice Address - Country:US
Practice Address - Phone:614-544-0101
Practice Address - Fax:614-544-0102
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2022-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102201704207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2124374Medicaid
OHKE4237241Medicare PIN
OH2124374Medicaid