Individual
DR. STEPHEN LOUIS BRENNEKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
10121 SE SUNNYSIDE RD, SUITE 130, CLACKAMAS, OR 97015-5745
(503) 766-3545
(503) 342-3766
Mailing address
10121 SE SUNNYSIDE RD, SUITE 130, CLACKAMAS, OR 97015-5745
(503) 766-3545
(503) 342-3766
Taxonomy
Speciality
Code
Description
License number
State
207XS0114X
Adult Reconstructive Orthopaedic Surgery Physician
Primary
MD11314
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
112187
MEDICARE GROUP
OR
Enumeration date
10/19/2005
Last updated
03/01/2011
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