Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0122X | Plastic and Reconstructive Surgery | MD13741 | OR |
NPI | 1003980889 |
---|---|
Provider Name | James A Kilgore |
First Address | Tualatin, OR 97062 |
Second Address | Tualatin, OR 97062 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/11/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
21950 1 | (05) | OR |
E08345 | (02) |