Provider Demographics
NPI:1306948591
Name:KERN, DEBORAH LEIGH (MD)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:LEIGH
Last Name:KERN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 26666
Mailing Address - Street 2:PHS PROVIDER ENROLLMENT
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87125-6666
Mailing Address - Country:US
Mailing Address - Phone:505-923-6770
Mailing Address - Fax:505-923-5354
Practice Address - Street 1:1000 ALPINE AVE
Practice Address - Street 2:SUITE #100
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80304-3406
Practice Address - Country:US
Practice Address - Phone:303-442-2150
Practice Address - Fax:303-442-3363
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2018-07-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NMMD2008-0635207Q00000X
CO37445207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO23778377Medicaid
H28121Medicare UPIN
CO23778377Medicaid