Provider Demographics
NPI:1598127912
Name:KEPHART, DONALD TOWLE
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:TOWLE
Last Name:KEPHART
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4860 Y ST
Mailing Address - Street 2:STE 3800 DEPARTMENT OF ORTHOPEDIC SURGERY
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95817-2307
Mailing Address - Country:US
Mailing Address - Phone:916-734-2807
Mailing Address - Fax:916-703-5074
Practice Address - Street 1:4860 Y ST
Practice Address - Street 2:STE 3800 DEPARTMENT OF ORTHOPEDIC SURGERY
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95817-2307
Practice Address - Country:US
Practice Address - Phone:916-734-2807
Practice Address - Fax:916-703-5074
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-24
Last Update Date:2016-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program