Provider Demographics
NPI:1457337115
Name:KEMPER, ELLEN LORRAINE (MD)
Entity Type:Individual
Prefix:DR
First Name:ELLEN
Middle Name:LORRAINE
Last Name:KEMPER
Suffix:
Gender:F
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:PO BOX 309
Mailing Address - Street 2:
Mailing Address - City:CRAIG
Mailing Address - State:AK
Mailing Address - Zip Code:99921
Mailing Address - Country:US
Mailing Address - Phone:907-826-2235
Mailing Address - Fax:907-755-4981
Practice Address - Street 1:7300 KLAWOCK HOLLIS HIGHWAY
Practice Address - Street 2:
Practice Address - City:KLAWOCK
Practice Address - State:AK
Practice Address - Zip Code:99925
Practice Address - Country:US
Practice Address - Phone:907-755-4800
Practice Address - Fax:907-755-4981
Is Sole Proprietor?:No
Enumeration Date:2005-12-15
Last Update Date:2007-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM5212207Q00000X
AK5943207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA35077OtherL & I
AKMD6258Medicaid
8HZ11TMedicare ID - Type Unspecified
AKMD6258Medicaid
AK8EE006Medicare PIN