Individual
DR. DOUGLAS BRUCE MCKEAG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD, MS
Contact information
Practice address
4411 SW VERMONT ST, PORTLAND, OR 97219-1020
(503) 494-9992
Mailing address
4411 SW VERMONT ST, PORTLAND, OR 97219-1020
(503) 494-9992
Taxonomy
Speciality
Code
Description
License number
State
207QS0010X
Sports Medicine (Family Medicine) Physician
Primary
MD167303
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200259190
—
IN
01
—
P00800740
RR MEDICARE
IN
Enumeration date
04/19/2006
Last updated
07/25/2014
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