Individual
MYLES DAVID KEROACK
Active
Individual
MYLES DAVID KEROACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
72672
MA
207RG0100X
Gastroenterology Physician
Primary
55795
WI
207RG0100X
Gastroenterology Physician
72672
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
072672
TUFTS HEALTH PLAN
MA
05
—
3088898
—
MA
01
—
J10606
BCBS MA
MA
Enumeration date
11/10/2005
Last updated
07/06/2011
Update your record
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