Provider Demographics
NPI:1972522019
Name:FLEMMER, KRISTEN ELIZABETH (MD)
Entity Type:Individual
Prefix:MRS
First Name:KRISTEN
Middle Name:ELIZABETH
Last Name:FLEMMER
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 1:100 SW BASELINE ST
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97123-3971
Mailing Address - Country:US
Mailing Address - Phone:503-681-4273
Mailing Address - Fax:503-681-1953
Practice Address - Street 1:100 SW BASELINE ST
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97123-3971
Practice Address - Country:US
Practice Address - Phone:503-681-4273
Practice Address - Fax:503-681-1953
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2015-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD18550207Q00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR150082Medicaid
OR150082Medicaid
ORR158810Medicare PIN