Healthcare Provider Details

I. General information

NPI: 1922113638
Provider Name (Legal Business Name): STEVEN MATTHEW SANDOR M.B., CH.B.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 07/11/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10100 SE SUNNYSIDE RD KAISER PERMANENTE MT. TALBERT MEDICAL OFFICE
CLACKAMAS OR
97015-8970
US

IV. Provider business mailing address

10100 SE SUNNYSIDE RD KAISER PERMANENTE MT. TALBERT MEDICAL OFFICE
CLACKAMAS OR
97015-8970
US

V. Phone/Fax

Practice location:
  • Phone: 503-285-9321
  • Fax:
Mailing address:
  • Phone: 503-285-9321
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD07825
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD00014396
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: