Provider Demographics
NPI:1700889672
Name:KERR, ALBERT GLEN (MD)
Entity Type:Individual
Prefix:DR
First Name:ALBERT
Middle Name:GLEN
Last Name:KERR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 749
Mailing Address - Street 2:
Mailing Address - City:RAYVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71269-0749
Mailing Address - Country:US
Mailing Address - Phone:318-728-0175
Mailing Address - Fax:318-728-0173
Practice Address - Street 1:121 CHRISTIAN DR
Practice Address - Street 2:
Practice Address - City:RAYVILLE
Practice Address - State:LA
Practice Address - Zip Code:71269-3658
Practice Address - Country:US
Practice Address - Phone:318-728-0175
Practice Address - Fax:318-728-0173
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-24
Last Update Date:2011-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA019435207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1377686Medicaid
LA1377686Medicaid
LAB65643Medicare UPIN