Individual
DR. KENNETH PAUL MELVIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4035 MERCANTILE DR, SUITE 112, LAKE OSWEGO, OR 97035-2546
(503) 203-1177
(503) 203-1178
Mailing address
6975 SW SANDBURG ST, SUITE 190, PORTLAND, OR 97223-8073
(503) 639-0600
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
MD 24232
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
269812
—
OR
01
—
MD24232
MEDICAL LICENCE NUMBER
OR
Enumeration date
04/17/2006
Last updated
03/07/2023
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