Provider Demographics
NPI:1891151908
Name:KEMP, WALTER LOREN (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:WALTER
Middle Name:LOREN
Last Name:KEMP
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 N COLUMBIA RD
Mailing Address - Street 2:MAILSTOP 9037, RM. 5933
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58203-2817
Mailing Address - Country:US
Mailing Address - Phone:701-777-6941
Mailing Address - Fax:
Practice Address - Street 1:501 N COLUMBIA RD
Practice Address - Street 2:MAILSTOP 9037, RM. 5933
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58203-2817
Practice Address - Country:US
Practice Address - Phone:701-777-6941
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-05
Last Update Date:2016-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND13727207ZF0201X
MT10002207ZF0201X
TXL5007207ZF0201X
SD9509207ZF0201X
MN59727207ZF0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZF0201XAllopathic & Osteopathic PhysiciansPathologyForensic Pathology