Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204D00000X | Neuromusculoskeletal Medicine (NMM) | DO17457 | OR |
Y | 207Q00000X | Family Doctor | DO17457 | OR |
NPI | 1043254378 |
---|---|
Provider Name | Keith W Kale |
First Address | Portland, OR 97220-3961 |
Second Address | Portland, OR 97220-3961 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/06/2006 |
Last Update Date | 27/01/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036207 | (05) | OR |
F00103 | (02) | OR |