Provider Demographics
NPI:1205812732
Name:KINSLEY, STEPHEN JAY (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:JAY
Last Name:KINSLEY
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 1:67266 WILD RHODIE DR
Mailing Address - Street 2:
Mailing Address - City:NORTH BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97459-8681
Mailing Address - Country:US
Mailing Address - Phone:541-756-2421
Mailing Address - Fax:
Practice Address - Street 1:USCG SECTOR-AIR STATION NORTH BEND
Practice Address - Street 2:2000 CONNECTICUT AVE
Practice Address - City:NORTH BEND
Practice Address - State:OR
Practice Address - Zip Code:97459
Practice Address - Country:US
Practice Address - Phone:541-756-9237
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-05-7309207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHE37107Medicare UPIN