Individual
DR. KELLY R MCCORMICK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1600 STATE ST, SALEM, OR 97301-4257
(503) 540-6300
(503) 540-6404
Mailing address
1600 STATE ST, SALEM, OR 97301-4257
(503) 540-6300
(503) 540-6404
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
MD157529
OR
207X00000X
Orthopaedic Surgery Physician
MT189201
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500647558
—
OR
Enumeration date
05/30/2008
Last updated
06/10/2019
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