Individual
KERRY JOE JAMES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
SA-C
Taxonomy
Speciality
Code
Description
License number
State
246ZC0007X
Surgical Assistant
238000599
IL
363AS0400X
Surgical Physician Assistant
Primary
06-179
MO
Other
Enumeration date
01/11/2007
Last updated
11/29/2023
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