Provider Demographics
NPI:1255412839
Name:KERNAN, JOHN B (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:B
Last Name:KERNAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:5419 N LOVINGTON HWY STE 13
Mailing Address - Street 2:
Mailing Address - City:HOBBS
Mailing Address - State:NM
Mailing Address - Zip Code:88240-9135
Mailing Address - Country:US
Mailing Address - Phone:505-392-7798
Mailing Address - Fax:505-392-4926
Practice Address - Street 1:5419 N LOVINGTON HWY STE 13
Practice Address - Street 2:
Practice Address - City:HOBBS
Practice Address - State:NM
Practice Address - Zip Code:88240-9135
Practice Address - Country:US
Practice Address - Phone:505-392-7798
Practice Address - Fax:505-392-4926
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2018-04-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NM78-47173000000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No173000000XOther Service ProvidersLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMC97881Medicare UPIN
NM2125824Medicare ID - Type Unspecified