Provider Demographics
NPI:1215952049
Name:KERR, PEPPER J (MD)
Entity type:Individual
Prefix:
First Name:PEPPER
Middle Name:J
Last Name:KERR
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:PEPPER
Other - Middle Name:J
Other - Last Name:HENYON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:915 HIGHLAND BLVD
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-6902
Mailing Address - Country:US
Mailing Address - Phone:406-414-4900
Mailing Address - Fax:
Practice Address - Street 1:937 HIGHLAND BLVD STE 5320
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-6916
Practice Address - Country:US
Practice Address - Phone:406-414-4900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT10083208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT47658Medicaid
MT91005OtherBCBS
H93697Medicare UPIN
MT47658Medicaid