Provider Demographics
NPI:1932106929
Name:KERO, SHAWKAT H (MD)
Entity Type:Individual
Prefix:
First Name:SHAWKAT
Middle Name:H
Last Name:KERO
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 1:11373 CORTEZ BLVD #401
Mailing Address - Street 2:
Mailing Address - City:BROOKSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:34613
Mailing Address - Country:US
Mailing Address - Phone:352-596-8995
Mailing Address - Fax:352-597-0002
Practice Address - Street 1:11373 CORTEZ BLVD #401
Practice Address - Street 2:
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34613
Practice Address - Country:US
Practice Address - Phone:352-596-8995
Practice Address - Fax:352-597-0002
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-05
Last Update Date:2019-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME43866207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL069665000Medicaid
FL26060Medicare ID - Type Unspecified