Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0100X | Gastroenterologist | A128828 | CA |
NPI | 1033476262 |
---|---|
Provider Name | Thomas Michael Kemmerly |
First Address | Murrieta, CA 92562-5786 |
Second Address | Murrieta, CA 92562-5786 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/04/2012 |
Last Update Date | 16/04/2018 |