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NPI Code Detail

MEDICARE: MR. RANDALL LEON KEMP D.O.

MEDICARE: MR. RANDALL LEON KEMP D.O.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician2875OK

General Provider Information

NPI Number : 1326043803
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. RANDALL LEON KEMP D.O.
Provider Business Mailing Address
First Line : 2403 W WRANGLER BLVD
Second Line : STE A
City : SEMINOLE
State : OK
Zip : 74868-1917
Country : US
Telephone Number : 405-382-4939
Fax Number : 405-382-4947
Provider Business Practice Location Address
First Line : 2403 W WRANGLER BLVD
Second Line : STE A
City : SEMINOLE
State : OK
Zip : 74868-1917
Country : US
Telephone Number : 405-382-4939
Fax Number : 405-382-4947
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/20/2005
Last Update Date : 07/08/2007

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