Individual
THOMAS ROBERT STASSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
5308 N LOMBARD ST, PORTLAND, OR 97203-4218
(888) 227-3312
Mailing address
PO BOX 3158, PORTLAND, OR 97208-3158
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
PA157168
OR
363A00000X
Physician Assistant
Primary
PA61117345
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500652003
—
OR
Enumeration date
10/16/2012
Last updated
10/19/2021
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