Organization
KELLY L MCKERAHAN D O A PROFESSIONAL MEDICAL CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KELLY LEE MCKERAHAN D.O. (PHYSICIAN)
(951) 696-9566
Entity
Organization
Contact information
Practice address
25095 JEFFERSON AVE STE 202, MURRIETA, CA 92562-9107
(951) 696-9566
(951) 696-9536
Mailing address
25095 JEFFERSON AVE STE 202, MURRIETA, CA 92562-9107
(951) 696-9566
(951) 696-9536
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
20A6780
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
GQ212A
PTAN
—
Enumeration date
10/30/2012
Last updated
11/13/2012
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