Provider Demographics
NPI:1598185712
Name:DUNCAN, KYLE J (DPM)
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:J
Last Name:DUNCAN
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 1:620 NW 11TH ST STE M201
Mailing Address - Street 2:
Mailing Address - City:HERMISTON
Mailing Address - State:OR
Mailing Address - Zip Code:97838-6941
Mailing Address - Country:US
Mailing Address - Phone:541-289-7075
Mailing Address - Fax:541-314-4873
Practice Address - Street 1:620 NW 11TH ST STE M201
Practice Address - Street 2:
Practice Address - City:HERMISTON
Practice Address - State:OR
Practice Address - Zip Code:97838-6941
Practice Address - Country:US
Practice Address - Phone:541-289-7075
Practice Address - Fax:541-314-4873
Is Sole Proprietor?:No
Enumeration Date:2014-04-27
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDP196169213ES0103X
OR196169213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2297OtherPODIATRY LICENSE