Individual
KIM A WAYSON
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
9155 SW BARNES RD, SUITE 440, PORTLAND, OR 97225-6625
(503) 297-3766
(503) 296-1168
Mailing address
9155 SW BARNES RD, SUITE 440, PORTLAND, OR 97225-6625
(503) 297-3766
(503) 296-1168
Taxonomy
Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
Primary
MD13269
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
155754
—
OR
Enumeration date
09/27/2005
Last updated
07/08/2007
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