Individual
JOHN KINGMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
18610 NW CORNELL RD, SUITE 300, HILLSBORO, OR 97124-9204
(503) 216-9300
(503) 216-9363
Mailing address
PO BOX 3158, PORTLAND, OR 97208-3158
(503) 215-6494
(503) 215-6644
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD17111
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
169784
—
OR
01
—
P00351748
RR MEDICARE
OR
Enumeration date
06/05/2006
Last updated
10/08/2012
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