Provider Demographics
NPI:1598755878
Name:LINDEN, KENNETH L (MD)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:L
Last Name:LINDEN
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 1:895 MOOREA DR
Mailing Address - Street 2:
Mailing Address - City:ROSEBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97470-5532
Mailing Address - Country:US
Mailing Address - Phone:541-440-8439
Mailing Address - Fax:
Practice Address - Street 1:1887 W HARVARD AVE
Practice Address - Street 2:
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97470-2718
Practice Address - Country:US
Practice Address - Phone:541-673-4303
Practice Address - Fax:541-440-9739
Is Sole Proprietor?:No
Enumeration Date:2005-10-26
Last Update Date:2007-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD 168902085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR013008Medicaid
ORR00WCGFTGMedicare PIN
00WCGFTGMedicare ID - Type Unspecified
OR013008Medicaid