Provider Demographics
NPI:1174591341
Name:WEBSTER, KIM BARCLAY (MD, PC)
Entity type:Individual
Prefix:DR
First Name:KIM
Middle Name:BARCLAY
Last Name:WEBSTER
Suffix:
Gender:M
Credentials:MD, PC
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2525 NW LOVEJOY ST
Mailing Address - Street 2:STE 408
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97210-2859
Mailing Address - Country:US
Mailing Address - Phone:503-973-5545
Mailing Address - Fax:503-973-5541
Practice Address - Street 1:2525 NW LOVEJOY ST
Practice Address - Street 2:STE 408
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97210-2859
Practice Address - Country:US
Practice Address - Phone:503-973-5545
Practice Address - Fax:503-973-5541
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OR15098174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist