Healthcare Provider Details

I. General information

NPI: 1487884052
Provider Name (Legal Business Name): KIRK ELLIOT WHETSTONE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2009
Last Update Date: 07/08/2025
Certification Date: 07/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1836 NE 7TH AVE STE 206
PORTLAND OR
97212-3998
US

IV. Provider business mailing address

1836 NE 7TH AVE STE 206
PORTLAND OR
97212-3998
US

V. Phone/Fax

Practice location:
  • Phone: 614-329-8956
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberMD197637
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License NumberMD197637
License Number StateOR
# 3
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number35.123988
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: