Provider Demographics
NPI:1831152370
Name:KERR, JEFFERY ALAN (DO)
Entity type:Individual
Prefix:DR
First Name:JEFFERY
Middle Name:ALAN
Last Name:KERR
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1050 W 10TH ST
Mailing Address - Street 2:
Mailing Address - City:ROLLA
Mailing Address - State:MO
Mailing Address - Zip Code:65401-2905
Mailing Address - Country:US
Mailing Address - Phone:573-364-9000
Mailing Address - Fax:
Practice Address - Street 1:1000 GW LN
Practice Address - Street 2:
Practice Address - City:WAYNESVILLE
Practice Address - State:MO
Practice Address - Zip Code:65583-2339
Practice Address - Country:US
Practice Address - Phone:573-842-4116
Practice Address - Fax:573-433-2008
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-07
Last Update Date:2019-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOMOR8F45207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO26-8630OtherRH MEDICARE
MO1447412770OtherRH MEDICAID (CLINIC)
MO242285732Medicaid
MO001013579Medicare ID - Type Unspecified
MO1447412770OtherRH MEDICAID (CLINIC)
MO242285732Medicaid