Provider Demographics
NPI:1578583928
Name:KEARNEY, JOHN A JR (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:A
Last Name:KEARNEY
Suffix:JR
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 1:18444 N 25TH AVE
Mailing Address - Street 2:STE 310
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85023-1266
Mailing Address - Country:US
Mailing Address - Phone:623-537-5600
Mailing Address - Fax:866-939-2673
Practice Address - Street 1:10494 W THUNDERBIRD BLVD
Practice Address - Street 2:STE 102
Practice Address - City:SUN CITY
Practice Address - State:AZ
Practice Address - Zip Code:85351-3058
Practice Address - Country:US
Practice Address - Phone:623-537-5600
Practice Address - Fax:866-939-2673
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ35801207Q00000X, 207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ5550830007OtherMEDICARE NSC DV
AZ5550830008OtherMEDICARE NSC SWV
AZ5550830003OtherMEDICARE NSC PEORIA
AZ5550830004OtherMEDICARE NSC PV
AZ5550830009OtherMEDICARE NSC AZ NORTH
AZ124466Medicaid
AZ5550830006OtherMEDICARE NSC ANTHEM
AZ5550830001OtherMEDICARE NSC SCW
AZ5550830010OtherMEDICARE NSC GILBERT
AZ5550830010OtherMEDICARE NSC GILBERT
AZI62399Medicare UPIN