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Individual

KRISTIN R STEVENS

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MD

Contact information

Practice address
417 SW 117TH AVE, SUITE 210, PORTLAND, OR 97225-5924
(503) 216-9400
Mailing address
PO BOX 3158, PORTLAND, OR 97208-3158
(503) 215-6494
(503) 215-6644

Taxonomy

Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
MD24617
OR

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
227482
OR
01
P00078476
RR MEDICARE
OR
Enumeration date
07/14/2006
Last updated
12/22/2021
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