Provider Demographics
NPI:1922001932
Name:FIELDER, KATHLEEN LOUISE (MD)
Entity Type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:LOUISE
Last Name:FIELDER
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 1:19260 SW 65TH AVE
Mailing Address - Street 2:STE 435
Mailing Address - City:TUALATIN
Mailing Address - State:OR
Mailing Address - Zip Code:97062-7707
Mailing Address - Country:US
Mailing Address - Phone:503-692-2032
Mailing Address - Fax:503-692-4450
Practice Address - Street 1:19260 SW 65TH AVE
Practice Address - Street 2:STE 435
Practice Address - City:TUALATIN
Practice Address - State:OR
Practice Address - Zip Code:97062-7707
Practice Address - Country:US
Practice Address - Phone:503-692-2032
Practice Address - Fax:503-692-4450
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2013-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD11747207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR181784Medicaid
WA1089719Medicaid
OR181784Medicaid
WA1089719Medicaid
ORC92615Medicare UPIN