Provider Demographics
NPI:1356304190
Name:KERSEY, ROBERT CHARLES (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:CHARLES
Last Name:KERSEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6567 E CARONDELET DR
Mailing Address - Street 2:SUITE 415
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85710-2156
Mailing Address - Country:US
Mailing Address - Phone:520-885-6701
Mailing Address - Fax:520-885-9037
Practice Address - Street 1:6567 E CARONDELET DR STE 415
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85710-6157
Practice Address - Country:US
Practice Address - Phone:520-887-7700
Practice Address - Fax:520-318-7107
Is Sole Proprietor?:No
Enumeration Date:2006-04-11
Last Update Date:2019-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ23793207X00000X, 207XS0106X, 207XS0114X, 207XX0004X, 207XX0801X, 207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
No207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic Surgery
No207XX0004XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryFoot and Ankle Surgery
No207XX0801XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Trauma
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ543290Medicaid
AZ20-3604285OtherTIN
AZZ121640Medicare PIN
H16795Medicare UPIN