Individual
DR. KELLY LEAF
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
24800 SE STARK ST, EMERGENCY DEPARTMENT, GRESHAM, OR 97030-3378
(503) 674-1122
Mailing address
24800 SE STARK ST, EMERGENCY DEPARTMENT, GRESHAM, OR 97030-3378
(503) 674-1122
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
MD22901
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
202438
WA L&I
—
05
—
287166
—
OR
05
—
8370835
—
WA
01
—
858543006
REGENCE BC/BS
—
Enumeration date
04/10/2006
Last updated
11/03/2015
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