Provider Demographics
NPI:1326128133
Name:KILLEN, RONALD HUGH (MD)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:HUGH
Last Name:KILLEN
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 1:16161 DUSTY LANE
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:OR
Mailing Address - Zip Code:97055
Mailing Address - Country:US
Mailing Address - Phone:503-803-9073
Mailing Address - Fax:
Practice Address - Street 1:1415 TULANE AVE
Practice Address - Street 2:HC 71
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70112-2600
Practice Address - Country:US
Practice Address - Phone:504-988-5888
Practice Address - Fax:866-403-1780
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2007-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR15428207L00000X
LA15288207L00000X
CA40053207L00000X
WA24467207L00000X
WA25209207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1177172Medicaid
MS01234269Medicaid
GAP00404442OtherRR MEDICARE
OR176867Medicaid
MS01234269Medicaid
C94394Medicare UPIN
OR0000BHWVPMedicare ID - Type Unspecified