Provider Demographics
NPI:1235198581
Name:KERR, ROGER MAURICE (MD)
Entity Type:Individual
Prefix:
First Name:ROGER
Middle Name:MAURICE
Last Name:KERR
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 1:2612 34TH ST
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90405-3115
Mailing Address - Country:US
Mailing Address - Phone:310-396-6175
Mailing Address - Fax:310-450-8595
Practice Address - Street 1:8 CADILLAC DR
Practice Address - Street 2:STE. 200
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-5087
Practice Address - Country:US
Practice Address - Phone:615-376-7370
Practice Address - Fax:615-376-7575
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2013-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG494982085R0202X
TN465782085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G494981Medicaid
CAA51382Medicare UPIN
CA00G494981Medicaid
TN103I308595Medicare PIN