Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | M-10673 | ID |
N | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | MD151135 | OR |
NPI | 1669607172 |
---|---|
Provider Name | Travis Jay Kemp |
First Address | Boise, ID 83704-9066 |
Second Address | Boise, ID 83704-9066 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/05/2009 |
Last Update Date | 17/09/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
808378000 | (05) | ID |