Healthcare Provider Details

I. General information

NPI: 1255382735
Provider Name (Legal Business Name): DONALD KERRY KEELER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 10/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

707 SW WASHINGTON ST STE 700
PORTLAND OR
97205-3536
US

IV. Provider business mailing address

PO BOX 35147 #1801
SEATTLE WA
98124-5147
US

V. Phone/Fax

Practice location:
  • Phone: 503-299-9906
  • Fax: 503-225-9002
Mailing address:
  • Phone: 503-299-9906
  • Fax: 503-225-9002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMD15087
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code207LC0200X
TaxonomyCritical Care Medicine (Anesthesiology) Physician
License NumberMD15087
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: