Individual
DR. KEITH LELAND IRONSIDE JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
6464 SW BORLAND RD, SUITE B2, TUALATIN, OR 97062-8876
(503) 612-9676
(866) 360-3540
Mailing address
6464 SW BORLAND RD, SUITE B2, TUALATIN, OR 97062-8876
(503) 612-9676
(866) 360-3540
Taxonomy
Speciality
Code
Description
License number
State
173F00000X
Sleep Specialist (PhD)
Primary
MD09750
OR
174400000X
Specialist
MD09750
OR
Other
Enumeration date
03/19/2009
Last updated
09/17/2013
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