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NPI Code Detail

MEDICARE: KELLEY HAINES GORSUCH

MEDICARE: KELLEY HAINES GORSUCH
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207P00000XEmergency Medicine PhysicianDO225954OR

General Provider Information

NPI Number : 1457819773
Entity Type Code : Individual
Provider Name (Legal Business Name) : KELLEY HAINES GORSUCH
Provider Business Mailing Address
First Line : 500 NE MULTNOMAH ST STE 100
Second Line :
City : PORTLAND
State : OR
Zip : 97232-2031
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 10180 SE SUNNYSIDE RD
Second Line :
City : CLACKAMAS
State : OR
Zip : 97015-8970
Country : US
Telephone Number : 800-813-2000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/05/2019
Last Update Date : 01/23/2026

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Directions to “ KELLEY HAINES GORSUCH ” Practice Location

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