Active NPI
Paul Duane McKernan, MD
- Obstetrics & Gynecology Physician
- Glendale, AZ
National Provider Identifier
1790788016
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Obstetrics & Gynecology Physician
- License
- 17534
- Practice address
- 18699 N 67TH Ave
Ste 320
Glendale, AZ 85308-7143 - Phone
- (623) 561-7250
- Fax
- (623) 561-0098
- NPI assigned
- May 31, 2005
- Reactivated
- Mar 29, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Obstetrics & Gynecology Physician | 207V00000X | 17534 | AZ | Primary |
Addresses
Primary practice location
18699 N 67TH Ave
Ste 320
Glendale, AZ 85308-7143
Mailing address
18699 N 67TH Ave
Ste 320
Glendale, AZ 85308-7143
Phone (623) 561-7250
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 280371 | Medicaid | AZ |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 17534 | AZ | MD | Obstetrics & Gynecology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1117497600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1783900800000",
"number": "1790788016",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "18699 N 67TH AVE",
"address_2": "STE 320",
"city": "GLENDALE",
"state": "AZ",
"postal_code": "853087143",
"telephone_number": "623-561-7250",
"fax_number": "623-561-0098"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "18699 N 67TH AVE",
"address_2": "STE 320",
"city": "GLENDALE",
"state": "AZ",
"postal_code": "853087143",
"telephone_number": "623-561-7250",
"fax_number": "623-561-0098"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MCKERNAN",
"first_name": "PAUL",
"middle_name": "DUANE",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-05-31",
"last_updated": "2026-07-13",
"deactivation_date": "2006-03-20",
"reactivation_date": "2006-03-29",
"status": "A"
},
"taxonomies": [
{
"code": "207V00000X",
"taxonomy_group": "",
"desc": "Obstetrics & Gynecology",
"state": "AZ",
"license": "17534",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "280371",
"state": "AZ"
}
],
"endpoints": [],
"other_names": []
}Other providers in Glendale, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.