Individual
KENNETH G PIPPUS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
9427 SW BARNES RD STE 395, PORTLAND, OR 97225-6652
(503) 216-6050
(503) 216-8658
Mailing address
PO BOX 3158, PORTLAND, OR 97208-3158
(503) 215-6494
(503) 215-6644
Taxonomy
Speciality
Code
Description
License number
State
2086S0120X
Pediatric Surgery Physician
41464
CO
2086S0120X
Pediatric Surgery Physician
Primary
MD152536
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
44331282
—
CO
05
—
500624953
—
OR
Enumeration date
10/05/2006
Last updated
03/24/2021
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