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General NPI Number Information
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NPI Number | 1245228980
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Entity Type | Organization
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Legal Business Name | KLAMATH FA MILY PRACTICE CENTER PC
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Dates
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Enumeration Date | 10/06/2005
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 2310 MOUNTAIN VIEW BLVD
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City | KLAMATH FALLS
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State | OR
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Zip | 97601-1134
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Country | US
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Telephone | 541-238-6432
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Fax | 541-539-6439
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Provider Business Mailing Address
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Address Line | PO BOX 5234
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City | KLAMATH FALLS
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State | OR
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Zip | 97601-0203
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Country | US
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Telephone | 541-238-6462
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Fax | 541-539-6439
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Authorized Official
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Title or Position | PRESIDENT
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Name | JON G MCKELLAR
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Credential | MD
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Telephone | 541-238-6462
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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