Provider Demographics
NPI:1124126636
Name:AVISON, KATHRINE ELAINE (MD)
Entity type:Individual
Prefix:DR
First Name:KATHRINE
Middle Name:ELAINE
Last Name:AVISON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5050 NE HOYT
Mailing Address - Street 2:SUITE 469
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97213-2984
Mailing Address - Country:US
Mailing Address - Phone:503-231-7747
Mailing Address - Fax:503-231-7724
Practice Address - Street 1:5050 NE HOYT
Practice Address - Street 2:SUITE 469
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97213-2984
Practice Address - Country:US
Practice Address - Phone:503-231-7747
Practice Address - Fax:503-231-7724
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR10105207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR005066Medicaid
C94256Medicare UPIN
104277Medicare ID - Type Unspecified