Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | 000000 | PA |
Y | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | DP202065 | OR |
N | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | SC006916 | PA |
N | 213ES0103X | Foot & Ankle Surgery | DP202065 | OR |
N | 213ES0103X | Foot & Ankle Surgery | SC006916 | PA |
N | 213ES0131X | Foot Surgery | DP202065 | OR |
NPI | 1699272724 |
---|---|
Provider Name | Dr. Kevin Dennis Driscoll |
First Address | Portland, OR 97213-3864 |
Second Address | Portland, OR 97213-3864 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/04/2018 |
Last Update Date | 30/09/2021 |