Provider Demographics
NPI:1225227531
Name:KELLER, DOUGLAS CRAIG (PA-C)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:CRAIG
Last Name:KELLER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1515 NW 18TH AVE
Mailing Address - Street 2:STE 300
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97209-2539
Mailing Address - Country:US
Mailing Address - Phone:503-249-0719
Mailing Address - Fax:503-249-0749
Practice Address - Street 1:501 N GRAHAM ST
Practice Address - Street 2:SUITE 250
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97227-1654
Practice Address - Country:US
Practice Address - Phone:503-249-0719
Practice Address - Fax:503-249-0749
Is Sole Proprietor?:No
Enumeration Date:2007-10-23
Last Update Date:2022-03-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ORPA01210363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant