Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2081P2900X | Pain Medicine | MD156934 | OR |
NPI | 1316140965 |
---|---|
Provider Name | Russell Robert Kinder |
First Address | Portland, OR 97216-2462 |
Second Address | Portland, OR 97216-2462 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/06/2007 |
Last Update Date | 17/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1316140965 | (05) | WA |