Individual
KERRY COUNCILMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1348 NE CUSHING DR, BEND, OR 97701-3876
(541) 382-7696
Mailing address
1348 NE CUSHING DR, BEND, OR 97701-3876
(541) 382-7696
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
48166
CO
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
48166
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
20824713
—
CO
Enumeration date
09/15/2008
Last updated
03/03/2026
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