Provider Demographics
NPI:1699272724
Name:DRISCOLL, KEVIN DENNIS (DPM)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:DENNIS
Last Name:DRISCOLL
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6108 NE GLISAN ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97213-3864
Mailing Address - Country:US
Mailing Address - Phone:503-255-8100
Mailing Address - Fax:503-255-2728
Practice Address - Street 1:6108 NE GLISAN ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97213-3864
Practice Address - Country:US
Practice Address - Phone:503-255-8100
Practice Address - Fax:503-255-2728
Is Sole Proprietor?:No
Enumeration Date:2018-04-05
Last Update Date:2021-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA000000207XX0004X
PASC006916207XX0004X, 213ES0103X
ORDP202065213ES0103X, 213ES0131X, 207XX0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0004XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryFoot and Ankle Surgery
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery