Basic Information
| Provider Information | |||||||||
| NPI: | 1750382404 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KERBS | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | R | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 700 N COLUMBUS ST | ||||||||
| Address2: | |||||||||
| City: | CRESTLINE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 448271455 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4194687059 | ||||||||
| FaxNumber: | 4194686962 | ||||||||
| Practice Location | |||||||||
| Address1: | 955 HOSFORD RD | ||||||||
| Address2: | |||||||||
| City: | GALION | ||||||||
| State: | OH | ||||||||
| PostalCode: | 448339325 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4194687059 | ||||||||
| FaxNumber: | 4194686962 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/03/2005 | ||||||||
| LastUpdateDate: | 12/30/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/30/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | 35058529 | OH | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 0897883 | 05 | OH | MEDICAID |