Provider Demographics
NPI:1366486003
Name:KERN, JOSHUA WILLIAM (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:WILLIAM
Last Name:KERN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 587
Mailing Address - Street 2:
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83303-0587
Mailing Address - Country:US
Mailing Address - Phone:208-814-7400
Mailing Address - Fax:208-814-7491
Practice Address - Street 1:132 5TH AVE W
Practice Address - Street 2:SUITE 1
Practice Address - City:JEROME
Practice Address - State:ID
Practice Address - Zip Code:83338-1825
Practice Address - Country:US
Practice Address - Phone:208-814-9800
Practice Address - Fax:208-814-9835
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2015-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM9857207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID806424400Medicaid
ID807192700Medicaid
ID133843Medicare PIN
ID807192700Medicaid
ID806424400Medicaid