Healthcare Provider Details

I. General information

NPI: 1235230707
Provider Name (Legal Business Name): KENNETH HUGH MCCARLEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 06/26/2025
Certification Date: 06/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 HILYARD ST STE 620
EUGENE OR
97401-8157
US

IV. Provider business mailing address

1200 HILYARD ST STE 620
EUGENE OR
97401-8157
US

V. Phone/Fax

Practice location:
  • Phone: 458-205-6500
  • Fax: 458-205-6453
Mailing address:
  • Phone: 458-205-6500
  • Fax: 458-205-6453

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License Number28710
License Number StateTN

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1811876
Identifier TypeMEDICAID
Identifier StateTN
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: