Individual
DR. JIMMY MICHAEL KERLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
104 NW 31ST, LAWTON, OK 73505
(580) 536-2121
(580) 536-2150
Mailing address
PO BOX 6130, LAWTON, OK 73506
(580) 536-2121
(580) 536-2150
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
G3515
TX
207RH0003X
Hematology & Oncology Physician
G3515
TX
2085R0001X
Radiation Oncology Physician
Primary
30531
OK
2085R0001X
Radiation Oncology Physician
G3515
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100101320A
—
OK
05
—
13876404
—
TX
05
—
138876101
—
TX
05
—
138876102
—
TX
05
—
138876105
—
TX
05
—
138876106
—
TX
05
—
138876108
—
TX
05
—
138876111
—
TX
05
—
138876112
—
TX
01
—
8R1484
BLUE CROSS OF TX
TX
Enumeration date
06/01/2006
Last updated
05/06/2014
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