Provider Demographics
NPI:1962694042
Name:VERMILION, KENDALL J (MD)
Entity type:Individual
Prefix:DR
First Name:KENDALL
Middle Name:J
Last Name:VERMILION
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:DAVID GRANT MEDICAL CENTER
Mailing Address - Street 2:101 BODIN CIRCLE
Mailing Address - City:TRAVIS AFB
Mailing Address - State:CA
Mailing Address - Zip Code:94535
Mailing Address - Country:US
Mailing Address - Phone:707-423-5433
Mailing Address - Fax:707-423-5426
Practice Address - Street 1:DAVID GRANT MEDICAL CENTER
Practice Address - Street 2:101 BODIN CIRCLE
Practice Address - City:TRAVIS AFB
Practice Address - State:CA
Practice Address - Zip Code:94535
Practice Address - Country:US
Practice Address - Phone:707-423-5433
Practice Address - Fax:707-423-5426
Is Sole Proprietor?:No
Enumeration Date:2007-08-13
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101245478171000000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Yes171000000XOther Service ProvidersMilitary Health Care ProviderGroup - Single Specialty