Provider Demographics
NPI:1447476080
Name:KAMMERER, KURT DORSON
Entity type:Individual
Prefix:
First Name:KURT
Middle Name:DORSON
Last Name:KAMMERER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 E ROUND GROVE RD
Mailing Address - Street 2:APT. # 722
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75067-3875
Mailing Address - Country:US
Mailing Address - Phone:806-438-8355
Mailing Address - Fax:
Practice Address - Street 1:300 E ROUND GROVE RD
Practice Address - Street 2:APT. # 722
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75067-3875
Practice Address - Country:US
Practice Address - Phone:806-438-8355
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT3510390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program