Healthcare Provider Details

I. General information

NPI: 1215226014
Provider Name (Legal Business Name): KENNETH MICHAEL DOWNES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2011
Last Update Date: 07/19/2024
Certification Date: 07/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7110 WYOMING BLVD NE
ALBUQUERQUE NM
87109-4867
US

IV. Provider business mailing address

3375 SW TERWILLIGER BLVD
PORTLAND OR
97239-4146
US

V. Phone/Fax

Practice location:
  • Phone: 505-346-0500
  • Fax: 505-346-0164
Mailing address:
  • Phone: 503-494-3929
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberA123717
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberMD176549
License Number StateOR
# 3
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberMD2017-0187
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: