Healthcare Provider Details

I. General information

NPI: 1508086067
Provider Name (Legal Business Name): KELLY S PERLEWITZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2007
Last Update Date: 03/24/2021
Certification Date: 03/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1003 PROVIDENCE DR STE 310
NEWBERG OR
97132-7521
US

IV. Provider business mailing address

PO BOX 3158
PORTLAND OR
97208-3158
US

V. Phone/Fax

Practice location:
  • Phone: 503-537-6040
  • Fax: 503-537-6045
Mailing address:
  • Phone: 503-215-6494
  • Fax: 503-215-6644

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License NumberMD27666
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: