Provider Demographics
NPI:1669688354
Name:KERN, JACK ALAN (MD)
Entity Type:Individual
Prefix:DR
First Name:JACK
Middle Name:ALAN
Last Name:KERN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:201 LAURENCE DR
Mailing Address - Street 2:107
Mailing Address - City:HEATH
Mailing Address - State:TX
Mailing Address - Zip Code:75032-2069
Mailing Address - Country:US
Mailing Address - Phone:214-906-0749
Mailing Address - Fax:972-564-5124
Practice Address - Street 1:201 LAURENCE DR
Practice Address - Street 2:107
Practice Address - City:HEATH
Practice Address - State:TX
Practice Address - Zip Code:75032-2069
Practice Address - Country:US
Practice Address - Phone:214-906-0749
Practice Address - Fax:972-564-5124
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD2250174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist