Healthcare Provider Details

I. General information

NPI: 1619979952
Provider Name (Legal Business Name): DAVID LEE KILLION MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2005
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 9TH AVE STE 120
LONGVIEW WA
98632-2465
US

IV. Provider business mailing address

10200 GRAND CENTRAL AVE STE 220
OWINGS MILLS MD
21117-4366
US

V. Phone/Fax

Practice location:
  • Phone: 360-636-8950
  • Fax: 360-636-8951
Mailing address:
  • Phone: 520-795-5830
  • Fax: 520-885-4469

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberMD224797
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number22220
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberW0430
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberMD61665978
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: