Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224P00000X | Prosthetist | CPO03713 |
NPI | 1356840821 |
---|---|
Provider Name | Kevyn Maxwell Mcghee |
First Address | Portland, OR 97239-2964 |
Second Address | Portland, OR 97239-2964 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/02/2018 |
Last Update Date | 09/02/2018 |