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General NPI Number Information
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NPI Number | 1902995194
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Entity Type | Individual
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Provider Name | KATHLEEN ANNE WALDORF MD
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Gender | Female
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Dates
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Enumeration Date | 10/12/2006
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Last Update Date | 03/12/2013
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Provider Practice Location Address
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Address Line | 9775 SW WILSHIRE ST SUITE 200
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City | PORTLAND
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State | OR
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Zip | 97225
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Country | US
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Telephone | 503-646-0101
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Fax | 503-350-1420
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Provider Business Mailing Address
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Address Line | 9775 SW WILSHIRE ST. SUITE 200
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City | PORTLAND
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State | OR
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Zip | 97225
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Country | US
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Telephone | 503-646-0101
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Fax | 503-350-1420
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | MD16987
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number | MD16987
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License Number State | OR
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