Basic Information
| Provider Information | |||||||||
| NPI: | 1235353996 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | THOMAS | ||||||||
| FirstName: | KRISTEN | ||||||||
| MiddleName: | LEIGH | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 501 N GRAHAM ST | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972272000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5034134488 | ||||||||
| FaxNumber: | 5034131812 | ||||||||
| Practice Location | |||||||||
| Address1: | 501 N GRAHAM ST | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972272000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5034134488 | ||||||||
| FaxNumber: | 5034131813 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/12/2007 | ||||||||
| LastUpdateDate: | 01/31/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | 252969 | NY | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207X00000X | 164327 | OR | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
No ID Information.