1740416262 NPI number — DR. SEAN QUIGLEY KERN M.D.

Table of content: DR. SEAN QUIGLEY KERN M.D. (NPI 1740416262)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740416262 NPI number — DR. SEAN QUIGLEY KERN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KERN
Provider First Name:
SEAN
Provider Middle Name:
QUIGLEY
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1740416262
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/30/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 JARRETT WHITE RD
Provider Second Line Business Mailing Address:
TRIPLER ARMY MEDICAL CENTER
Provider Business Mailing Address City Name:
TRIPLER ARMY MEDICAL CENTER
Provider Business Mailing Address State Name:
HI
Provider Business Mailing Address Postal Code:
96859-5001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
808-433-2961
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
535 BARNHILL DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
INDIANAPOLIS
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46202-5116
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
317-944-7541
Provider Business Practice Location Address Fax Number:
317-944-0174
Provider Enumeration Date:
06/10/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208800000X , with the licence number:  0101265710 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208800000X , with the licence number: 01082048A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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