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Organization

KENNETH P MELVIN, MD, PC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. KENNETH PAUL MELVIN MD (PRESIDENT)
(503) 203-1177
Entity
Organization

Contact information

Practice address
4035 MERCANTILE DR, SUITE 112, LAKE OSWEGO, OR 97035-2546
(503) 203-1177
(503) 203-1178
Mailing address
4035 MERCANTILE DR, SUITE 112, LAKE OSWEGO, OR 97035-2546
(503) 203-1177
(503) 203-1178

Taxonomy

Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
MD24232
OR

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
MD24232
OREGON LICENSE
OR
Enumeration date
02/29/2008
Last updated
02/29/2008
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