Individual
KENNETH LEE RECKARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
19250 SW 90TH AVE, TUALATIN, OR 97062-7585
(503) 692-3750
(503) 691-2324
Mailing address
847 NE 19TH AVE, SUITE 300, PORTLAND, OR 97232-2684
(503) 963-2801
(503) 963-2801
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA01082
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1083635916
—
WA
05
—
500604351
—
OR
Enumeration date
07/23/2006
Last updated
12/01/2021
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