Provider Demographics
NPI:1659357333
Name:KERNER, BRUCE ALAN (MD)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:ALAN
Last Name:KERNER
Suffix:
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 1:5965 E BROAD ST
Mailing Address - Street 2:SUITE 120
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43213-1562
Mailing Address - Country:US
Mailing Address - Phone:614-864-1000
Mailing Address - Fax:614-864-1444
Practice Address - Street 1:5965 E BROAD ST
Practice Address - Street 2:SUITE 120
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43213-1562
Practice Address - Country:US
Practice Address - Phone:614-864-1000
Practice Address - Fax:614-864-1444
Is Sole Proprietor?:No
Enumeration Date:2005-12-15
Last Update Date:2022-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35060131174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0791782Medicaid
OHKE0673761Medicare ID - Type UnspecifiedDOWNTOWN OFFICE
OH0791782Medicaid
OHKE0673762Medicare ID - Type UnspecifiedEAST OFFICE