Provider Demographics
NPI:1679549992
Name:KEMP, JON R (MD)
Entity Type:Individual
Prefix:DR
First Name:JON
Middle Name:R
Last Name:KEMP
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 E FAIRVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:OLIVIA
Mailing Address - State:MN
Mailing Address - Zip Code:56277-4213
Mailing Address - Country:US
Mailing Address - Phone:320-523-1460
Mailing Address - Fax:320-523-1703
Practice Address - Street 1:611 E FAIRVIEW AVE
Practice Address - Street 2:
Practice Address - City:OLIVIA
Practice Address - State:MN
Practice Address - Zip Code:56277-4213
Practice Address - Country:US
Practice Address - Phone:320-523-1460
Practice Address - Fax:320-523-1703
Is Sole Proprietor?:No
Enumeration Date:2006-02-27
Last Update Date:2013-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN37158207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN523027600Medicaid
MN080005057Medicare ID - Type Unspecified
MN523027600Medicaid