Provider Demographics
NPI:1386252906
Name:KYLE J. DUNCAN, DPM, LLC
Entity type:Organization
Organization Name:KYLE J. DUNCAN, DPM, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:
Authorized Official - Last Name:DUNCAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:682-702-6870
Mailing Address - Street 1:5300 W 23RD AVE
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99338-2530
Mailing Address - Country:US
Mailing Address - Phone:682-702-6870
Mailing Address - Fax:
Practice Address - Street 1:1122 W ELM AVE
Practice Address - Street 2:
Practice Address - City:HERMISTON
Practice Address - State:OR
Practice Address - Zip Code:97838-6933
Practice Address - Country:US
Practice Address - Phone:541-567-1750
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-20
Last Update Date:2020-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty