Individual
JOHN MCKENNA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2801 N GANTENBEIN AVE, PORTLAND, OR 97227-1623
(503) 413-4278
Mailing address
PO BOX 3777, PORTLAND, OR 97208-3777
(503) 413-3900
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
59812
TN
207V00000X
Obstetrics & Gynecology Physician
Primary
MD211959
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1698149
—
AK
Enumeration date
04/13/2015
Last updated
02/26/2024
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