Provider Demographics
NPI:1225124340
Name:ROGER M. KERR, M.D.,INC
Entity Type:Organization
Organization Name:ROGER M. KERR, M.D.,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:M
Authorized Official - Last Name:KERR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:213-741-8306
Mailing Address - Street 1:2400 S FLOWER ST
Mailing Address - Street 2:DEPT. OF RADIOLOGY
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90007-2629
Mailing Address - Country:US
Mailing Address - Phone:213-741-8306
Mailing Address - Fax:
Practice Address - Street 1:2400 S FLOWER ST
Practice Address - Street 2:DEPT. OF RADIOLOGY
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90007-2629
Practice Address - Country:US
Practice Address - Phone:213-741-8306
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2009-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G494980OtherBLUE SHIELD
AR00G494981Medicaid
AR00G494981Medicaid
BE897Medicare PIN