Provider Demographics
NPI:1346448461
Name:DAY, KEVIN ALLEN (MD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:ALLEN
Last Name:DAY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:KEVIN
Other - Middle Name:ALLEN
Other - Last Name:DAY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1128 NE 2ND ST STE 206
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97330-6230
Mailing Address - Country:US
Mailing Address - Phone:541-897-9717
Mailing Address - Fax:541-897-9717
Practice Address - Street 1:1128 NE 2ND ST STE 206
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330-6230
Practice Address - Country:US
Practice Address - Phone:541-897-9717
Practice Address - Fax:541-897-9717
Is Sole Proprietor?:No
Enumeration Date:2007-07-10
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV134992086S0122X, 208600000X
ORMD154125208200000X
WV22379208600000X
TNMD0000044964208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
No2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR169400Medicare UPIN