Individual
BENJAMIN DANIEL KEVAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ATC, PAC
Contact information
Practice address
3620 NW SAMARITAN DR STE 202, CORVALLIS, OR 97330-3785
(541) 768-4810
Mailing address
PO BOX 1189, CORVALLIS, OR 97339-1189
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
791039
WI
363A00000X
Physician Assistant
Primary
PA01366
OR
363A00000X
Physician Assistant
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Other
Enumeration date
05/18/2006
Last updated
11/10/2020
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