Individual
KERRI D DERREVERE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
707 SW GAINES ST, PORTLAND, OR 97239-2901
(405) 990-8777
Mailing address
707 SW GAINES ST, PORTLAND, OR 97239-2901
(405) 990-8777
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
MD158142
OR
Other
Enumeration date
07/07/2009
Last updated
02/25/2015
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