Individual
DR. KENNETH CHARLES DIRK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
9205 SW BARNES RD, PORTLAND, OR 97225-6603
(503) 297-6334
(503) 297-2360
Mailing address
9340 SW BARNES RD, SUITE 202, PORTLAND, OR 97225-6623
(503) 297-6334
(503) 297-2360
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
MD20699
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
134004
—
OR
01
—
930081411
UNITED HEALTHCARE
OR
Enumeration date
10/05/2006
Last updated
09/19/2023
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