Provider Demographics
NPI:1033303847
Name:STEVENS, KENNETH RICHARDS JR (MD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:RICHARDS
Last Name:STEVENS
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:3181 SW SAM JACKSON PARK RD.
Mailing Address - Street 2:KPV4, RADIATION MEDICINE
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-3098
Mailing Address - Country:US
Mailing Address - Phone:503-494-8756
Mailing Address - Fax:503-346-0237
Practice Address - Street 1:3181 SW SAM JACKSON PARK RD.
Practice Address - Street 2:KPV4, RADIATION MEDICINE
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-3098
Practice Address - Country:US
Practice Address - Phone:503-494-8756
Practice Address - Fax:503-346-0237
Is Sole Proprietor?:No
Enumeration Date:2007-09-05
Last Update Date:2007-09-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ORMD070592085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR048913Medicaid
OR048913Medicaid