Healthcare Provider Details

I. General information

NPI: 1801866421
Provider Name (Legal Business Name): JAMES KEMPA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

375 S MAIN ST # 140
MOAB UT
84532-2557
US

IV. Provider business mailing address

375 S MAIN ST # 140
MOAB UT
84532-2557
US

V. Phone/Fax

Practice location:
  • Phone: 661-714-0144
  • Fax:
Mailing address:
  • Phone: 661-714-0144
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number3590331205
License Number StateUT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier359033120010
Identifier TypeOTHER
Identifier StateUT
Identifier IssuerBLUE CROSS OF UT
# 2
IdentifierD5269
Identifier TypeMEDICAID
Identifier StateUT
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: