Individual
DR. STEVEN GARY TILLETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.P.M.
Contact information
Practice address
6274 SW CAPITOL HWY, PORTLAND, OR 97239-2674
(503) 246-2212
Mailing address
6274 SW CAPITOL HWY, PORTLAND, OR 97239-2674
(503) 246-2212
(503) 246-4050
Taxonomy
Speciality
Code
Description
License number
State
213ES0131X
Foot Surgery Podiatrist
Primary
DP00300
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
227113
OMAP
OR
05
—
227113
—
OR
01
—
480031007
RR MEDICARE
—
01
—
831001001
BC
—
Enumeration date
11/22/2005
Last updated
02/12/2020
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