| Doctor Name: | KENNETH LEE RECKARD |
| NPI Number: | 1083635916 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PA-C |
| License Number: | PA01082 |
| Business Practice Address: | 1508 Division St Ste 15 Oregon City, OR - 970451582 |
| Business Phone Number: | 5036923750 |
| Business Fax Number: | 5036912324 |
| Mailing Address: | 847 Ne 19th Ave, Suite 300 PORTLAND |
| State: | OR |
| Postal Code: | 972322684 |
| Phone Number: | 5039632801 |
| Fax Number: | 5039632801 |
| NPI Enumeration Date: | 07/23/2006 |
| NPI Last Update Date: | 09/11/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AM0700X |
| License Number: | PA01082 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OR |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Medical |
| Taxonomy Definition: | |