Provider Demographics
NPI:1295917508
Name:JILL E KERR, D. O. P.C.
Entity type:Organization
Organization Name:JILL E KERR, D. O. P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JILL
Authorized Official - Middle Name:E
Authorized Official - Last Name:KERR
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:480-250-2221
Mailing Address - Street 1:14020 S 31ST ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85048-8324
Mailing Address - Country:US
Mailing Address - Phone:480-250-2221
Mailing Address - Fax:
Practice Address - Street 1:13838 S 46TH PL
Practice Address - Street 2:SUITE 320
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85044-7800
Practice Address - Country:US
Practice Address - Phone:480-759-5151
Practice Address - Fax:480-940-8649
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-28
Last Update Date:2007-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3241207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZD41470Medicare UPIN