Provider Demographics
NPI:1407851454
Name:GREWE, KATHY (MD)
Entity Type:Individual
Prefix:DR
First Name:KATHY
Middle Name:
Last Name:GREWE
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:PO BOX 3390
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97208-3390
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1304 MONTELLO AVE
Practice Address - Street 2:
Practice Address - City:HOOD RIVER
Practice Address - State:OR
Practice Address - Zip Code:97031-1544
Practice Address - Country:US
Practice Address - Phone:541-387-6125
Practice Address - Fax:541-387-6315
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2016-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD16646207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR012067Medicaid
ORC16295Medicare UPIN
WAG8908715Medicare PIN
ORR163920Medicare PIN
WAG8857435Medicare PIN
ORR162454Medicare PIN
WAG8857435Medicare PIN