Individual
DR. STUTI CALLISTA FERNANDES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
3181 SW SAM JACKSON PARK RD, PORTLAND, OR 97239-3011
(503) 494-3273
(503) 494-6990
Mailing address
3181 SW SAM JACKSON PARK RD, PORTLAND, OR 97239-3011
(503) 494-3273
(503) 494-6990
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
MD186576
OR
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
Primary
MD186576
OR
390200000X
Student in an Organized Health Care Education/Training Program
—
CA
Other
Enumeration date
04/23/2015
Last updated
07/06/2020
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