Provider Demographics
NPI:1316140965
Name:KINDER, RUSSELL ROBERT (MD)
Entity type:Individual
Prefix:
First Name:RUSSELL
Middle Name:ROBERT
Last Name:KINDER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10000 SE MAIN ST STE 128
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97216-2462
Mailing Address - Country:US
Mailing Address - Phone:503-251-6835
Mailing Address - Fax:503-251-6836
Practice Address - Street 1:10000 SE MAIN ST STE 128
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97216-2462
Practice Address - Country:US
Practice Address - Phone:503-251-6835
Practice Address - Fax:503-251-6836
Is Sole Proprietor?:No
Enumeration Date:2007-06-08
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60232145207LP2900X
ORMD1569342081P2900X, 207LP2900X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1316140965Medicaid
G8927186Medicare PIN
WA1316140965Medicaid
WA8907790Medicare PIN
WAG8927184Medicare PIN
WAG8927185Medicare PIN