Waldorf, Kathleen Anne

Waldorf, Kathleen Anne is an sole proprietor health care provider with primary practice located at 9775 Sw Wilshire St Suite 200, Portland OR 97225. She recently has 2 registered licenses in different health care specialties including Other Service Providers / Specialist, Allopathic & Osteopathic Physicians / Plastic Surgery. Allopathic & Osteopathic Physicians / Plastic Surgery is her primary health care specialty. Waldorf, Kathleen Anne can be contacted via phone (503) 646-0101.

Contact Information

Primary practice address
9775 Sw Wilshire St Suite 200 Portland OR 97225
Phone: (503) 646-0101
Fax: (503) 350-1420
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Other Service Providers / Specialist 174400000X MD16987 Oregon
Allopathic & Osteopathic Physicians / Plastic Surgery 208200000X MD16987 Oregon

Profile Details

NPI number 1902995194
LBN Legal business name Waldorf, Kathleen Anne
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Oct 12th, 2006
Last updated Mar 12th, 2013 - about 11 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1902995194 NPPES
Oregon Other 93-111-8189 TAX IDENTIFICATION

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