Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | DO20375 | OR |
NPI | 1083608970 |
---|---|
Provider Name | Kevin J Kane |
First Address | Portland, OR 97266 |
Second Address | Portland, OR 97266 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/09/2005 |
Last Update Date | 28/08/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
06701800 | BCBSO (01) | OR |
108596 | (02) | OR |
3555836 | (05) | OR |