Provider Demographics
NPI:1295773463
Name:CAINE, KIRSTEN ELIZABETH TALLENT (MD)
Entity type:Individual
Prefix:DR
First Name:KIRSTEN
Middle Name:ELIZABETH TALLENT
Last Name:CAINE
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:PO BOX 1038
Mailing Address - Street 2:
Mailing Address - City:JOSEPH
Mailing Address - State:OR
Mailing Address - Zip Code:97846-1038
Mailing Address - Country:US
Mailing Address - Phone:541-432-7777
Mailing Address - Fax:
Practice Address - Street 1:100 N. EAST ST
Practice Address - Street 2:
Practice Address - City:JOSEPH
Practice Address - State:OR
Practice Address - Zip Code:97846
Practice Address - Country:US
Practice Address - Phone:541-432-7777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2010-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD24489207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR135586Medicare UPIN
OR131980Medicare ID - Type Unspecified