Individual
KELLY COLLINS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
3303 S BOND AVE # CH8N, PORTLAND, OR 97239-4501
(503) 494-4314
Mailing address
3840 SW DOSCH RD, PORTLAND, OR 97239-1431
(412) 260-0894
Taxonomy
Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
Primary
MD198904
OR
207T00000X
Neurological Surgery Physician
MD60581884
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MD198904
OREGON STATE MEDICAL LICENSE
OR
01
—
MD60581884
WASHINGTON STATE MEDICAL LICENSE
WA
Enumeration date
04/15/2011
Last updated
03/07/2023
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