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General NPI Number Information
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NPI Number | 1477584142
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Entity Type | Individual
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Provider Name | KATHRYN WOOD HOLMES M.D.
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Gender | Female
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Dates
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Enumeration Date | 07/05/2006
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Last Update Date | 08/23/2012
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Provider Practice Location Address
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Address Line | 3181 SW SAM JACKSON PARK RD MAIL CODE DC 7S
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City | PORTLAND
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State | OR
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Zip | 97239-3011
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Country | US
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Telephone | 503-418-5750
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Fax | 503-418-5793
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Provider Business Mailing Address
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Address Line | 3181 SW SAM JACKSON PARK RD MAIL CODE DC 7S
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City | PORTLAND
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State | OR
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Zip | 97239-3011
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Country | US
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Telephone | 503-418-5750
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Fax | 503-418-5793
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | D56586
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 2080P0202X
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Taxonomy Name | Pediatric Cardiology Physician
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License Number | MD156159
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License Number State | OR
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