Individual
KENNETH MICHAEL CARLSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1475 MOUNT HOOD AVE, WOODBURN, OR 97071-9099
(503) 981-1509
Mailing address
1475 MOUNT HOOD AVE, WOODBURN, OR 97071-9099
(503) 982-0626
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
MD22868
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
287244
—
OR
Enumeration date
07/06/2006
Last updated
05/08/2024
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