Provider Demographics
NPI:1942356605
Name:MACDONALD, KELVIN D (MD, RRT)
Entity Type:Individual
Prefix:DR
First Name:KELVIN
Middle Name:D
Last Name:MACDONALD
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Gender:M
Credentials:MD, RRT
Other - Prefix:
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Mailing Address - Street 1:707 SW GAINES ST
Mailing Address - Street 2:CDRCP
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-2901
Mailing Address - Country:US
Mailing Address - Phone:503-494-8023
Mailing Address - Fax:503-494-8898
Practice Address - Street 1:707 SW GAINES ST
Practice Address - Street 2:CDRCP
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-2901
Practice Address - Country:US
Practice Address - Phone:503-494-8023
Practice Address - Fax:503-494-8898
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2013-10-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MDD00620472080P0214X
ORMD1612122080P0214X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0214XAllopathic & Osteopathic PhysiciansPediatricsPediatric Pulmonology