Healthcare Provider Details

I. General information

NPI: 1285775957
Provider Name (Legal Business Name): DANIEL STEIN PAC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/08/2007
Last Update Date: 03/02/2026
Certification Date: 03/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4940 HAMRICK RD
CENTRAL POINT OR
97502-3072
US

IV. Provider business mailing address

1100 E MAIN ST STE 203
MEDFORD OR
97504-7435
US

V. Phone/Fax

Practice location:
  • Phone: 541-535-6239
  • Fax:
Mailing address:
  • Phone: 541-414-4787
  • Fax: 541-787-6293

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA154040
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberPA154040
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number18628
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: