Provider Demographics
NPI:1396957155
Name:KERR, DAVID CLARK (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:CLARK
Last Name:KERR
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 1:1700 COGDELL BLVD
Mailing Address - Street 2:
Mailing Address - City:SNYDER
Mailing Address - State:TX
Mailing Address - Zip Code:79549-6162
Mailing Address - Country:US
Mailing Address - Phone:325-573-1300
Mailing Address - Fax:325-573-2357
Practice Address - Street 1:1700 COGDELL BLVD
Practice Address - Street 2:
Practice Address - City:SNYDER
Practice Address - State:TX
Practice Address - Zip Code:79549
Practice Address - Country:US
Practice Address - Phone:325-573-1300
Practice Address - Fax:325-574-6944
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2024-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM6980207VX0000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX188260703Medicaid
TX8K4017Medicare PIN
TX8K4017Medicare Oscar/Certification