Provider Demographics
NPI:1831302090
Name:KERGER, CHRIS EVERETT (CP)
Entity Type:Individual
Prefix:MR
First Name:CHRIS
Middle Name:EVERETT
Last Name:KERGER
Suffix:
Gender:M
Credentials:CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3855 PRINCETON DR
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95405-7061
Mailing Address - Country:US
Mailing Address - Phone:707-579-9570
Mailing Address - Fax:707-579-4963
Practice Address - Street 1:3855 PRINCETON DR
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95405-7061
Practice Address - Country:US
Practice Address - Phone:707-579-9570
Practice Address - Fax:707-579-4963
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACPOO1524174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAXB0015240Medicaid