Provider Demographics
NPI:1881783090
Name:MEIGS, KENNETH J JR (DO)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:J
Last Name:MEIGS
Suffix:JR
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 82ND DR STE 100
Mailing Address - Street 2:
Mailing Address - City:GLADSTONE
Mailing Address - State:OR
Mailing Address - Zip Code:97027-2550
Mailing Address - Country:US
Mailing Address - Phone:503-831-9231
Mailing Address - Fax:503-656-8080
Practice Address - Street 1:15 82ND DR STE 100
Practice Address - Street 2:
Practice Address - City:GLADSTONE
Practice Address - State:OR
Practice Address - Zip Code:97027-2550
Practice Address - Country:US
Practice Address - Phone:503-831-9231
Practice Address - Fax:503-656-8080
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDO18453207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR071410Medicaid
OR819827000OtherBLUE CROSS
OR112878Medicare ID - Type Unspecified
OR819827000OtherBLUE CROSS