Individual
TIMOTHY LYNN KEENEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
19260 SW 65TH AVE STE 270, TUALATIN, OR 97062
(503) 885-9391
(503) 563-5520
Mailing address
19260 SW 65TH AVE, SUITE 270, TUALATIN, OR 97062-5701
(503) 885-9391
(503) 563-5520
Taxonomy
Speciality
Code
Description
License number
State
207XS0117X
Orthopaedic Surgery of the Spine Physician
Primary
MD15842
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
215608
—
OR
01
—
R113019
MEDICARE PTAN
—
Enumeration date
11/03/2005
Last updated
08/15/2018
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