Provider Demographics
NPI:1093817363
Name:KERRY, ROBERT MARK (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:MARK
Last Name:KERRY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:548 MORGAN HARE RD
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71203-8414
Mailing Address - Country:US
Mailing Address - Phone:318-345-3867
Mailing Address - Fax:
Practice Address - Street 1:3421 MEDICAL PARK DR
Practice Address - Street 2:ST FRANCIS NORTH HOSPITAL
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71211
Practice Address - Country:US
Practice Address - Phone:318-388-7874
Practice Address - Fax:318-361-4629
Is Sole Proprietor?:No
Enumeration Date:2006-09-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA017151207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1345211Medicaid
LA1345211Medicaid
B62539Medicare UPIN