Provider Demographics
NPI:1508037151
Name:DAVID S. KERMODE, DO PC
Entity Type:Organization
Organization Name:DAVID S. KERMODE, DO PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:DAIVD
Authorized Official - Middle Name:S
Authorized Official - Last Name:KERMODE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:660-665-3640
Mailing Address - Street 1:800 W JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:KIRKSVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63501-1443
Mailing Address - Country:US
Mailing Address - Phone:660-665-3640
Mailing Address - Fax:660-262-2004
Practice Address - Street 1:800 W JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:KIRKSVILLE
Practice Address - State:MO
Practice Address - Zip Code:63501-1443
Practice Address - Country:US
Practice Address - Phone:660-665-3640
Practice Address - Fax:660-626-2004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-21
Last Update Date:2009-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR4H42208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO000015706Medicare PIN