Individual
JACK EZRA KEEGAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
33 NW BROADWAY, PORTLAND, OR 97209-3580
(503) 228-7134
Mailing address
232 NW 6TH AVE, PORTLAND, OR 97209-3609
(503) 294-1681
(503) 294-4321
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
200740083RN
OR
Other
Enumeration date
04/01/2020
Last updated
04/01/2020
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