Individual
DR. KATHLEEN BAKER MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1700 E 19TH ST, THE DALLES, OR 97058-3317
(541) 296-1111
Mailing address
PO BOX 4800, UNIT 17, PORTLAND, OR 97208-4800
(888) 633-0087
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
MD24465
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
200126
WA L & I
—
05
—
227377
—
OR
05
—
8120099
—
WA
01
—
8906937
WA CRIME VICTIMS
—
01
—
P00242572
RAILROAD
—
05
—
XPY206683
—
CA
Enumeration date
06/06/2006
Last updated
01/17/2008
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