Provider Demographics
NPI:1225387129
Name:POULSEN, KEITH PAPPAS (DVM, PHD)
Entity Type:Individual
Prefix:DR
First Name:KEITH
Middle Name:PAPPAS
Last Name:POULSEN
Suffix:
Gender:M
Credentials:DVM, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 SW 30TH ST
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97331-8628
Mailing Address - Country:US
Mailing Address - Phone:608-338-6444
Mailing Address - Fax:
Practice Address - Street 1:700 SW 30TH ST
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97331-8628
Practice Address - Country:US
Practice Address - Phone:608-338-6444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-06
Last Update Date:2012-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5662174M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174M00000XOther Service ProvidersVeterinarian