Provider Demographics
NPI:1063629251
Name:MOYER, KATHRYN D (MD)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:D
Last Name:MOYER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:D
Other - Last Name:MOYER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:300 N GRAHAM ST
Mailing Address - Street 2:SUITE 420
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97227-1683
Mailing Address - Country:US
Mailing Address - Phone:503-281-5139
Mailing Address - Fax:503-249-3782
Practice Address - Street 1:300 N GRAHAM ST
Practice Address - Street 2:SUITE 420
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97227-1683
Practice Address - Country:US
Practice Address - Phone:503-281-5139
Practice Address - Fax:503-249-3782
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2009-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH570112892080P0206X
ORMD258362080P0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0206XAllopathic & Osteopathic PhysiciansPediatricsPediatric Gastroenterology