Healthcare Provider Details

I. General information

NPI: 1386252906
Provider Name (Legal Business Name): KYLE J. DUNCAN, DPM, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2020
Last Update Date: 07/23/2020
Certification Date: 07/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1122 W ELM AVE
HERMISTON OR
97838-6933
US

IV. Provider business mailing address

5300 W 23RD AVE
KENNEWICK WA
99338-2530
US

V. Phone/Fax

Practice location:
  • Phone: 541-567-1750
  • Fax:
Mailing address:
  • Phone: 682-702-6870
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State

VIII. Authorized Official

Name: KYLE DUNCAN
Title or Position: PODIATRIST
Credential: DPM
Phone: 682-702-6870