# KYLE HOMERTGEN, DO, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1427481977
- **Authorized official:** KYLE D HOMERTGEN D.O (PHYSICIAN)
- **Authorized official phone:** (541) 602-4373

## Contact information

- **Practice address:** 442 NW 4TH ST, SUITE 101, CORVALLIS, OR 97330-6491
- **Practice address phone:** (541) 758-5047
- **Practice address fax:** (541) 758-3713
- **Mailing address:** PO BOX 1893, CORVALLIS, OR 97339-1893

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 204D00000X | Neuromusculoskeletal Medicine & OMM Physician | DO151041 | OR | Yes |

## Other

- **Enumeration date:** 08/19/2013
- **Last updated:** 08/19/2013