Provider Demographics
NPI:1578069548
Name:KEMPF, DUSTIN BLAKE (DO)
Entity Type:Individual
Prefix:
First Name:DUSTIN
Middle Name:BLAKE
Last Name:KEMPF
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:DUSTIN
Other - Middle Name:BLAKE
Other - Last Name:THORNTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:270 LANSING ISLAND DR
Mailing Address - Street 2:
Mailing Address - City:INDIAN HARBOUR BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32937-5101
Mailing Address - Country:US
Mailing Address - Phone:321-693-5905
Mailing Address - Fax:
Practice Address - Street 1:5515 PEACH ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16509-2603
Practice Address - Country:US
Practice Address - Phone:814-868-2476
Practice Address - Fax:814-868-2476
Is Sole Proprietor?:No
Enumeration Date:2018-03-30
Last Update Date:2020-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
PAOT0204282084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program