Individual
DR. JON STEPHAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
10123 SE MARKET ST, PORTLAND, OR 97216-2532
(503) 257-2500
Mailing address
1400 SW 5TH AVE, PORTLAND, OR 97201-5537
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
MD19821
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
050044964
RR MEDICARE
OR
05
—
081070
—
OR
05
—
8195232
—
WA
Enumeration date
08/02/2006
Last updated
02/06/2024
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