Provider Demographics
NPI:1437442290
Name:KEMP, RYAN S (DPM)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:S
Last Name:KEMP
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:809 N LIBERTY ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-8703
Mailing Address - Country:US
Mailing Address - Phone:208-327-0627
Mailing Address - Fax:208-376-5258
Practice Address - Street 1:809 N LIBERTY ST
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-8703
Practice Address - Country:US
Practice Address - Phone:208-327-0627
Practice Address - Fax:208-376-5258
Is Sole Proprietor?:No
Enumeration Date:2011-05-26
Last Update Date:2021-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN07001189B213ES0103X
CAE5142213ES0103X
IDP-240213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery