Provider Demographics
NPI:1295732261
Name:KEMPLE, KIP L (MD)
Entity type:Individual
Prefix:DR
First Name:KIP
Middle Name:L
Last Name:KEMPLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:2230 NW PETTYGROVE
Mailing Address - Street 2:#120
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97210
Mailing Address - Country:US
Mailing Address - Phone:503-223-1840
Mailing Address - Fax:503-274-8970
Practice Address - Street 1:2230 NW PETTYGROVE
Practice Address - Street 2:#120
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97210
Practice Address - Country:US
Practice Address - Phone:503-223-1840
Practice Address - Fax:503-274-8970
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-05
Last Update Date:2010-03-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ORMD10387207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR104745Medicaid
OR104745Medicaid
ORR0000BHHPWMedicare ID - Type Unspecified