Individual
KENNETH M LECLERC
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
19250 SW 65TH AVE, SUITE 265, TUALATIN, OR 97062
(503) 413-7162
(503) 692-2101
Mailing address
PO BOX 3777, PORTLAND, OR 97208-3777
(503) 413-3900
(503) 413-3710
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
L4038
TX
207RC0000X
Cardiovascular Disease Physician
Primary
MD172293
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500685619
—
OR
Enumeration date
08/02/2005
Last updated
02/01/2017
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