Provider Demographics
NPI:1275521916
Name:MCKELLAR, JON GREGORY (MD)
Entity Type:Individual
Prefix:
First Name:JON
Middle Name:GREGORY
Last Name:MCKELLAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2218 SHALLOCK AVE
Mailing Address - Street 2:
Mailing Address - City:KLAMATH FALLS
Mailing Address - State:OR
Mailing Address - Zip Code:97601-4290
Mailing Address - Country:US
Mailing Address - Phone:541-882-3818
Mailing Address - Fax:541-882-9800
Practice Address - Street 1:2218 SHALLOCK AVE
Practice Address - Street 2:
Practice Address - City:KLAMATH FALLS
Practice Address - State:OR
Practice Address - Zip Code:97601-4290
Practice Address - Country:US
Practice Address - Phone:541-883-8134
Practice Address - Fax:541-883-1510
Is Sole Proprietor?:No
Enumeration Date:2005-10-06
Last Update Date:2019-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD11585207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR1245228980OtherNPI
ORR08WCHTWBMedicare PIN
ORR0000WCHTWMedicare PIN
ORAO1278Medicare UPIN