Basic Information
| Provider Information | |||||||||
| NPI: | 1316909997 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KERNBERG | ||||||||
| FirstName: | MARTIN | ||||||||
| MiddleName: | E | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1225 MARSHALL ST | ||||||||
| Address2: | STE 7 | ||||||||
| City: | CRESCENT CITY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 955312281 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7074641989 | ||||||||
| FaxNumber: | 7074649593 | ||||||||
| Practice Location | |||||||||
| Address1: | 800 E WASHINGTON BLVD | ||||||||
| Address2: | |||||||||
| City: | CRESCENT CITY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 955318359 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7074641989 | ||||||||
| FaxNumber: | 7074649593 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/06/2006 | ||||||||
| LastUpdateDate: | 06/19/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | G62629 | CA | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 207P00000X | G62629 | CA | N | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.