Basic Information
| Provider Information | |||||||||
| NPI: | 1457570707 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JERGE | ||||||||
| FirstName: | KARI | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 45680 | ||||||||
| Address2: | |||||||||
| City: | SAN FRANCISCO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 941456432 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5306262618 | ||||||||
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| Practice Location | |||||||||
| Address1: | 7400 E OSBORN RD | ||||||||
| Address2: | |||||||||
| City: | SCOTTSDALE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852516432 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4808825730 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/25/2007 | ||||||||
| LastUpdateDate: | 08/12/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 08/12/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2086S0127X | 46317 | AZ | N | Allopathic & Osteopathic Physicians | Surgery | Trauma Surgery | 208600000X | C166068 | CA | Y | Allopathic & Osteopathic Physicians | Surgery | 208600000X | 46317 | AZ | N | Allopathic & Osteopathic Physicians | Surgery | 208600000X | 036137808 | IL | N | Allopathic & Osteopathic Physicians | Surgery | 2086S0102X | 46317 | AZ | N | Allopathic & Osteopathic Physicians | Surgery | Surgical Critical Care |
ID Information
| ID | Type | State | Issuer | Description | Z91719 | 01 | AZ | MEDICARE PTAN | OTHER |