Provider Demographics
NPI:1386909851
Name:KURZET, KYLE MOORE (MD)
Entity type:Individual
Prefix:
First Name:KYLE
Middle Name:MOORE
Last Name:KURZET
Suffix:
Gender:X
Credentials:MD
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:KURZET MOORE
Other - Last Name:WOLPERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1623 OAK ST
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-4022
Mailing Address - Country:US
Mailing Address - Phone:541-357-7594
Mailing Address - Fax:503-343-6242
Practice Address - Street 1:1623 OAK ST
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-4022
Practice Address - Country:US
Practice Address - Phone:541-357-7594
Practice Address - Fax:503-343-6242
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-10
Last Update Date:2024-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8736463-1205207Q00000X
IDM-12656207Q00000X
PAMD479943207Q00000X
WAMD60824368207Q00000X
NV18519207Q00000X
ORMD181577207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500772209Medicaid