Provider Demographics
NPI:1326043803
Name:KEMP, RANDALL LEON (DO)
Entity Type:Individual
Prefix:MR
First Name:RANDALL
Middle Name:LEON
Last Name:KEMP
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:2403 W WRANGLER BLVD
Mailing Address - Street 2:STE A
Mailing Address - City:SEMINOLE
Mailing Address - State:OK
Mailing Address - Zip Code:74868-1917
Mailing Address - Country:US
Mailing Address - Phone:405-382-4939
Mailing Address - Fax:405-382-4947
Practice Address - Street 1:2403 W WRANGLER BLVD
Practice Address - Street 2:STE A
Practice Address - City:SEMINOLE
Practice Address - State:OK
Practice Address - Zip Code:74868-1917
Practice Address - Country:US
Practice Address - Phone:405-382-4939
Practice Address - Fax:405-382-4947
Is Sole Proprietor?:No
Enumeration Date:2005-06-20
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OK2875207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
E70379Medicare UPIN