Individual
KELLY DEE RUTHERFORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2211 E MILL PLAIN BLVD, VANCOUVER, WA 98661-4329
(360) 418-6001
Mailing address
4103 COLTSFOOT LN, LAKE OSWEGO, OR 97035-1868
(503) 636-1316
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
OR MD 12376
OR
207Q00000X
Family Medicine Physician
Primary
WA MD00018278
WA
Other
Enumeration date
11/08/2006
Last updated
07/08/2007
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