Provider Demographics
NPI:1750688404
Name:KRISTEN E FLEMMER MD PC
Entity Type:Organization
Organization Name:KRISTEN E FLEMMER MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KRISTEN
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:FLEMMER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:503-681-4273
Mailing Address - Street 1:333 SE 7TH AVE STE 5550
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97123-5193
Mailing Address - Country:US
Mailing Address - Phone:503-681-4273
Mailing Address - Fax:503-681-1953
Practice Address - Street 1:333 SE 7TH AVE STE 5550
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97123-5193
Practice Address - Country:US
Practice Address - Phone:503-681-4273
Practice Address - Fax:503-681-1953
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-15
Last Update Date:2011-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD18550207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR150082Medicaid
OR150082Medicaid
ORR103677Medicare PIN