Individual
KEEVIN BYBEE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1321 NE 99TH AVE, STE 100, PORTLAND, OR 97220-9436
(503) 215-9900
Mailing address
PO BOX 3158, PORTLAND, OR 97208-3158
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD170326
OR
390200000X
Student in an Organized Health Care Education/Training Program
—
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500677725
—
OR
Enumeration date
05/03/2013
Last updated
02/20/2017
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