Provider Demographics
NPI:1245212901
Name:KEMP, JONATHAN ROBERT (MD)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:ROBERT
Last Name:KEMP
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 22009
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97269-2009
Mailing Address - Country:US
Mailing Address - Phone:503-558-7372
Mailing Address - Fax:503-344-5140
Practice Address - Street 1:10819 SE STARK ST
Practice Address - Street 2:SUITE 200
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97216-3161
Practice Address - Country:US
Practice Address - Phone:503-255-2291
Practice Address - Fax:503-252-1797
Is Sole Proprietor?:No
Enumeration Date:2005-11-17
Last Update Date:2021-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD21001207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR150956Medicaid
G07818Medicare UPIN
OR101319Medicare PIN