Healthcare Provider Details

I. General information

NPI: 1316103450
Provider Name (Legal Business Name): BRET T KEAN MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2008
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10121 SE SUNNYSIDE RD STE 100
CLACKAMAS OR
97015-5755
US

IV. Provider business mailing address

10121 SE SUNNYSIDE RD STE 201
CLACKAMAS OR
97015-5745
US

V. Phone/Fax

Practice location:
  • Phone: 503-659-1769
  • Fax: 503-659-7522
Mailing address:
  • Phone: 503-659-1769
  • Fax: 503-659-7522

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberMD28348
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License NumberMD28348
License Number StateOR

VIII. Authorized Official

Name: BRET THOMAS KEAN
Title or Position: OWNER
Credential: MD
Phone: 503-659-1769