Provider Demographics
NPI:1700879616
Name:KITTERMAN, JAMES FREDERICK (MD JD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:FREDERICK
Last Name:KITTERMAN
Suffix:
Gender:M
Credentials:MD JD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:132 E BROADWAY
Mailing Address - Street 2:STE 825
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-3143
Mailing Address - Country:US
Mailing Address - Phone:541-484-2430
Mailing Address - Fax:541-484-1796
Practice Address - Street 1:132 E BROADWAY
Practice Address - Street 2:STE 825
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-3143
Practice Address - Country:US
Practice Address - Phone:541-484-2430
Practice Address - Fax:541-484-1796
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-25
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD10762207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR194845Medicaid
OR194845Medicaid
OR194845Medicaid
C93055Medicare UPIN