Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | MD177683 | OR |
NPI | 1003159716 |
---|---|
Provider Name | Megan Lea Kelly |
First Address | Portland, OR 97209-3070 |
Second Address | Clackamas, OR 97015-8970 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/04/2013 |
Last Update Date | 04/02/2022 |