Individual
DR. STEPHEN P KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
707 SW WASHINGTON ST, STE 700, PORTLAND, OR 97205-3536
(503) 299-9906
(503) 225-9002
Mailing address
PO BOX 2040, PORTLAND, OR 97208-2040
(503) 299-9906
(503) 225-9002
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
MD11805
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
050031355
RR MEDICARE
OR
05
—
1770502
—
WA
05
—
226910
—
OR
05
—
MD805OR
—
AK
Enumeration date
05/17/2006
Last updated
09/10/2013
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