Provider Demographics
NPI:1831596642
Name:IRONS, KERRY (MD)
Entity type:Individual
Prefix:DR
First Name:KERRY
Middle Name:
Last Name:IRONS
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 1:701 W LOOP 340
Mailing Address - Street 2:SUITE A
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76712-6841
Mailing Address - Country:US
Mailing Address - Phone:254-776-0418
Mailing Address - Fax:254-741-9638
Practice Address - Street 1:2712 CRESTHILL CIR
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76710-1016
Practice Address - Country:US
Practice Address - Phone:254-776-5042
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-21
Last Update Date:2014-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE3712207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXB23706Medicare UPIN