Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204D00000X | Neuromusculoskeletal Medicine (NMM) | DO151041 | OR |
N | 207Q00000X | Family Doctor | 2075 | ME |
Y | 207Q00000X | Family Doctor | DO151041 | OR |
NPI | 1336266097 |
---|---|
Provider Name | Kyle D Homertgen |
First Address | Bend, OR 97702-1137 |
Second Address | Bend, OR 97702-1137 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/03/2007 |
Last Update Date | 22/03/2021 |