Provider Demographics
NPI:1417968173
Name:KERR, DOUGLAS P (MD)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:P
Last Name:KERR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2021 HERNDON AVE
Mailing Address - Street 2:STE 101
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93611-6316
Mailing Address - Country:US
Mailing Address - Phone:559-797-4315
Mailing Address - Fax:559-321-8730
Practice Address - Street 1:2021 HERNDON AVE
Practice Address - Street 2:# 101
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93611-6101
Practice Address - Country:US
Practice Address - Phone:559-981-5566
Practice Address - Fax:559-321-8730
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2020-05-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG69670207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G696700Medicaid
CA00G696700Medicaid