Provider Demographics
NPI:1851499750
Name:FRED KERSH DO PA
Entity Type:Organization
Organization Name:FRED KERSH DO PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FRED
Authorized Official - Middle Name:W
Authorized Official - Last Name:KERSH
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:903-593-9999
Mailing Address - Street 1:PO BOX 130757
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75713-0757
Mailing Address - Country:US
Mailing Address - Phone:903-593-9999
Mailing Address - Fax:903-526-4239
Practice Address - Street 1:906 E FRONT ST
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75702-8328
Practice Address - Country:US
Practice Address - Phone:903-593-9999
Practice Address - Fax:903-526-4239
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2007-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational MedicineGroup - Multi-Specialty