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General NPI Number Information
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NPI Number | 1639398845
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Entity Type | Individual
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Provider Name | MARSHAL TERRANCE KENNEDY DPM
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Gender | Male
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Dates
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Enumeration Date | 04/25/2007
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Last Update Date | 11/09/2013
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Provider Practice Location Address
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Address Line | 2775 SE POWELL VALLEY RD
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City | GRESHAM
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State | OR
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Zip | 97080-1475
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Country | US
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Telephone | 503-667-7789
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Fax | 503-667-2032
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Provider Business Mailing Address
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Address Line | 2775 SE POWELL VALLEY RD
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City | GRESHAM
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State | OR
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Zip | 97080-1475
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Country | US
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Telephone | 503-667-7789
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Fax | 503-667-2032
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | DP00139
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License Number State | OR
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