Provider Demographics
NPI:1972584753
Name:KYSER, JAMES P (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:P
Last Name:KYSER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 N GRAHAM ST STE 250
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97227-1666
Mailing Address - Country:US
Mailing Address - Phone:503-280-3418
Mailing Address - Fax:503-284-7885
Practice Address - Street 1:300 N GRAHAM ST STE 250
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97227-1666
Practice Address - Country:US
Practice Address - Phone:503-208-3418
Practice Address - Fax:503-284-7885
Is Sole Proprietor?:No
Enumeration Date:2005-11-09
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD25903208000000X, 2080P0202X
WAMD000451442080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR057775004OtherBLUE CROSS
WA1121946Medicaid
OR269922Medicaid