Individual
VENESSA STAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
11782 SW BARNES RD, SUITE 300, PORTLAND, OR 97225-5914
(503) 214-5200
Mailing address
11782 SW BARNES RD, SUITE 300, PORTLAND, OR 97225-5914
(503) 214-5200
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
MD151642
OR
207Q00000X
Family Medicine Physician
MD151642
OR
207X00000X
Orthopaedic Surgery Physician
Primary
MD151642
OR
207XS0114X
Adult Reconstructive Orthopaedic Surgery Physician
MD151642
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500634378
—
OR
01
—
MD151642
MEDICAL LICENSE
OR
Enumeration date
08/04/2009
Last updated
05/16/2022
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