Individual
DR. KATHLEEN ANNE WALDORF
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
9775 SW WILSHIRE ST, SUITE 200, PORTLAND, OR 97225
(503) 646-0101
(503) 350-1420
Mailing address
9775 SW WILSHIRE ST., SUITE 200, PORTLAND, OR 97225
(503) 646-0101
(503) 350-1420
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
MD16987
OR
208200000X
Plastic Surgery Physician
Primary
MD16987
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
93-111-8189
TAX IDENTIFICATION
OR
Enumeration date
10/12/2006
Last updated
03/12/2013
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