Provider Demographics
NPI:1942507819
Name:JAMES A KILGORE MD, PC
Entity Type:Organization
Organization Name:JAMES A KILGORE MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:R
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-691-0364
Mailing Address - Street 1:19250 SW 65TH AVE STE 365
Mailing Address - Street 2:
Mailing Address - City:TUALATIN
Mailing Address - State:OR
Mailing Address - Zip Code:97062-7747
Mailing Address - Country:US
Mailing Address - Phone:503-691-0364
Mailing Address - Fax:503-612-6663
Practice Address - Street 1:19250 SW 65TH AVE STE 365
Practice Address - Street 2:
Practice Address - City:TUALATIN
Practice Address - State:OR
Practice Address - Zip Code:97062-7747
Practice Address - Country:US
Practice Address - Phone:503-691-0364
Practice Address - Fax:503-612-6663
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-11
Last Update Date:2011-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty