Healthcare Provider Details

I. General information

NPI: 1588688402
Provider Name (Legal Business Name): JOHN THOMAS MANSFIELD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2265 EXCHANGE ST
ASTORIA OR
97103-3331
US

IV. Provider business mailing address

2111 EXCHANGE ST
ASTORIA OR
97103-3329
US

V. Phone/Fax

Practice location:
  • Phone: 503-338-4075
  • Fax: 503-338-4076
Mailing address:
  • Phone: 503-325-4321
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberMD215348
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: