Individual
PEGGY E KELLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
9427 SW BARNES RD STE 395, PORTLAND, OR 97225-6652
(503) 216-6050
Mailing address
PO BOX 3158, PORTLAND, OR 97208-3158
(503) 215-6494
Taxonomy
Speciality
Code
Description
License number
State
207YP0228X
Pediatric Otolaryngology Physician
37368
CO
207YP0228X
Pediatric Otolaryngology Physician
Primary
MD196930
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01373687
—
CO
Enumeration date
09/07/2006
Last updated
03/18/2021
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