Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0117X | Orthopaedic Spine Surgeon | MD15842 | OR |
NPI | 1194716571 |
---|---|
Provider Name | Timothy Lynn Keenen |
First Address | Tualatin, OR 97062-5701 |
Second Address | Tualatin, OR 97062 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/11/2005 |
Last Update Date | 15/08/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
215608 | (05) | OR |
A49072 | (02) | OR |
R113019 | MEDICARE PTAN (01) |