Doctor Name: | DR. KEITH PAPPAS POULSEN |
NPI Number: | 1225387129 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | DVM, PHD |
License Number: | 5662 |
Business Practice Address: | 700 Sw 30th St Corvallis, OR - 973318628 |
Business Phone Number: | 6083386444 |
Business Fax Number: | |
Mailing Address: | 700 Sw 30th St, CORVALLIS |
State: | OR |
Postal Code: | 973318628 |
Phone Number: | 6083386444 |
Fax Number: | |
NPI Enumeration Date: | 09/06/2012 |
NPI Last Update Date: | 09/06/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 174M00000X |
License Number: | 5662 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WI |
Taxonomy Type: | Other Service Providers |
Taxonomy Classification: | Veterinarian |
Taxonomy Specialization: | |
Taxonomy Definition: | A doctor of veterinary medicine, trained and authorized to practice veterinarian medicine and surgery. |