Provider Demographics
NPI:1952370405
Name:CARDER, KERRY ROBIN (MD)
Entity Type:Individual
Prefix:
First Name:KERRY
Middle Name:ROBIN
Last Name:CARDER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8315 WALNUT HILL LN
Mailing Address - Street 2:SUITE 135
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-4218
Mailing Address - Country:US
Mailing Address - Phone:214-580-1011
Mailing Address - Fax:214-580-1012
Practice Address - Street 1:8315 WALNUT HILL LN
Practice Address - Street 2:SUITE 135
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-4218
Practice Address - Country:US
Practice Address - Phone:214-580-1011
Practice Address - Fax:214-580-1012
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-16
Last Update Date:2015-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ4021207NP0225X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207NP0225XAllopathic & Osteopathic PhysiciansDermatologyPediatric Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX146646801Medicaid
H29966Medicare UPIN
TX8744N0Medicare ID - Type Unspecified