Provider Demographics
NPI:1760643290
Name:QUENCER, KEITH BERTRAM (MD)
Entity Type:Individual
Prefix:
First Name:KEITH
Middle Name:BERTRAM
Last Name:QUENCER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3181 SW SAM JACKSON PARK RD
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-3011
Mailing Address - Country:US
Mailing Address - Phone:503-494-7660
Mailing Address - Fax:503-494-4258
Practice Address - Street 1:3181 SW SAM JACKSON PARK RD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-3011
Practice Address - Country:US
Practice Address - Phone:503-494-7660
Practice Address - Fax:503-494-4258
Is Sole Proprietor?:No
Enumeration Date:2008-06-18
Last Update Date:2023-11-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA1020772085R0202X
ORMD2068022085R0202X, 2085R0204X
CT0532032085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology