Kelly L Mckerahan D O A Professional Medical Corporation | |
25095 Jefferson Ave Ste 202 Murrieta CA 92562-9107 | |
(951) 696-9566 | |
(951) 696-9536 |
Full Name | Kelly L Mckerahan D O A Professional Medical Corporation |
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Speciality | Clinic/Center |
Location | 25095 Jefferson Ave Ste 202, Murrieta, California |
Authorized Official Name and Position | Kelly Lee Mckerahan (PHYSICIAN) |
Authorized Official Contact | 9516969566 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Kelly L Mckerahan D O A Professional Medical Corporation 25095 Jefferson Ave Ste 202 Murrieta CA 92562-9107 Ph: (951) 696-9566 | Kelly L Mckerahan D O A Professional Medical Corporation 25095 Jefferson Ave Ste 202 Murrieta CA 92562-9107 Ph: (951) 696-9566 |
NPI Number | 1508110503 |
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Provider Enumeration Date | 10/30/2012 |
Last Update Date | 11/13/2012 |
Medicare PECOS PAC ID | 9234389024 |
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Medicare Enrollment ID | O20121102000097 |
Identifier | Type | State | Issuer |
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1508110503 | NPI | - | NPPES |
GQ212A | Other | PTAN |
Taxonomy | Type | License (State) | Status |
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261QP2300X | Clinic/center - Primary Care | 20A6780 (California) | Primary |
Provider Name | Kelly Mckerahan |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1184705790 PECOS PAC ID: 1557305158 Enrollment ID: I20050614001461 |
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