The Waldorf Center for Plastic Surgery

Primary specialty

Health Service Clinic/CenterTaxonomy code 261QH0100X

Legal business name

THE WALDORF CENTER FOR PLASTIC SURGERY

Practice address

12400 NW Cornell Rd Ste 200
Portland, OR 97229-5689

Phone

(503) 646-0101

Fax

(503) 350-1420

NPI assigned

Apr 9, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Kathleen A Waldorf, MD

Title

President, Owner, Physician

Phone

(503) 646-0101

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Stiles Turner Jewett Jr., M.D.

  • Plastic Surgery Physician
  • Portland, OR
  • NPI 1225123656
  NPD (past)
• Colleen D Phillips, PA-C

  • Surgical Physician Assistant
  • Portland, OR
  • NPI 1245308618
  NPD (past)
• Henry Daniel Zegzula, M.D.

  • Plastic Surgery Physician
  • Portland, OR
  • NPI 1811968639
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1176076800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1689797169",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12400 NW CORNELL RD STE 200",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972295689",
            "telephone_number": "503-646-0101",
            "fax_number": "503-350-1420"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12400 NW CORNELL RD STE 200",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972295689",
            "telephone_number": "503-646-0101",
            "fax_number": "503-350-1420"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE WALDORF CENTER FOR PLASTIC SURGERY",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-09",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "WALDORF",
        "authorized_official_first_name": "KATHLEEN",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PRESIDENT, OWNER, PHYSICIAN",
        "authorized_official_telephone_number": "503-646-0101",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QH0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Health Service",
            "state": "OR",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "060207",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• The Wallace Medical Concern
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• The Wellness Center PDX
• The Wig Gallery LLC

• Health Service Clinic/Center in Portland, OR
• Providers in Portland, OR by specialty
• Health Service Clinic/Center in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.