Individual
DR. KATHERINE ROLLINS BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1130 NW 22ND AVE STE 410, PORTLAND, OR 97210-2911
(503) 229-7137
(503) 241-0628
Mailing address
1130 NW 22ND AVE STE 410, PORTLAND, OR 97210-2911
(503) 229-7137
(503) 241-0628
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
MD156824
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500647193
—
OR
01
—
MD156824
PROVIDER STATE LICENSE
OR
Enumeration date
05/03/2007
Last updated
03/21/2013
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