Individual
KELLY JOHN CAVERZAGIE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3181 SW SAM JACKSON PARK RD, PORTLAND, OR 97239-3011
(503) 494-1164
(503) 494-5502
Mailing address
3181 SW SAM JACKSON PARK RD, PORTLAND, OR 97239-3011
(503) 494-1164
(503) 494-5502
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
22784
NE
207R00000X
Internal Medicine Physician
MD222456
OR
207R00000X
Internal Medicine Physician
MD426638
PA
208M00000X
Hospitalist Physician
Primary
MD222456
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
101537515
—
PA
Enumeration date
06/05/2006
Last updated
11/20/2024
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