Provider Demographics
NPI:1699060780
Name:PHELPS, MICHAEL KEITH (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:KEITH
Last Name:PHELPS
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Mailing Address - Street 1:16083 SW UPPER BOONES FERRY RD
Mailing Address - Street 2:SUITE 320
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97224-7736
Mailing Address - Country:US
Mailing Address - Phone:503-603-9087
Mailing Address - Fax:503-603-9122
Practice Address - Street 1:16083 SW UPPER BOONES FERRY RD
Practice Address - Street 2:SUITE 320
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97224-7736
Practice Address - Country:US
Practice Address - Phone:503-603-9087
Practice Address - Fax:503-603-9122
Is Sole Proprietor?:No
Enumeration Date:2011-06-16
Last Update Date:2015-02-03
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Provider Licenses
StateLicense IDTaxonomies
ORMD166497207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine