Provider Demographics
NPI:1659396711
Name:TRAUSTASON, KRISTINE E (MD)
Entity Type:Individual
Prefix:DR
First Name:KRISTINE
Middle Name:E
Last Name:TRAUSTASON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KRISTINE
Other - Middle Name:E
Other - Last Name:BUCHANAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1775 SW UMATILLA AVE
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:OR
Mailing Address - Zip Code:97756-7197
Mailing Address - Country:US
Mailing Address - Phone:541-548-7170
Mailing Address - Fax:541-548-3842
Practice Address - Street 1:1775 SW UMATILLA AVE
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:OR
Practice Address - Zip Code:97756-7197
Practice Address - Country:US
Practice Address - Phone:541-548-7170
Practice Address - Fax:541-548-3842
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2013-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD27028207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORP00464413OtherRAILROAD MEDICARE
OR007221Medicaid
OR053857011OtherREGENCE BCBS
OR76149OtherCLEAR CHOICE
ORP00464413OtherRAILROAD MEDICARE