Provider Demographics
NPI:1912984600
Name:KERR, JAY DEE (MD)
Entity Type:Individual
Prefix:
First Name:JAY
Middle Name:DEE
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 1:145 W UNIVERSITY PKWY
Mailing Address - Street 2:
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84058-7316
Mailing Address - Country:US
Mailing Address - Phone:801-234-8600
Mailing Address - Fax:801-234-8569
Practice Address - Street 1:145 W UNIVERSITY PKWY
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84058-7316
Practice Address - Country:US
Practice Address - Phone:801-234-8600
Practice Address - Fax:801-234-8569
Is Sole Proprietor?:No
Enumeration Date:2005-12-23
Last Update Date:2023-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA83824207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT7950759-1205OtherUTAH MEDICAL LICENSE
00A838242Medicare PIN
CAA83824OtherCALIF. LICENSE