Healthcare Provider Details

I. General information

NPI: 1700872785
Provider Name (Legal Business Name): STEVEN DOUGLAS MANESS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2005
Last Update Date: 10/14/2025
Certification Date: 10/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

440 NW DIVISION ST
GRESHAM OR
97030-5506
US

IV. Provider business mailing address

440 NW DIVISION ST
GRESHAM OR
97030-5506
US

V. Phone/Fax

Practice location:
  • Phone: 503-215-9500
  • Fax: 503-215-9525
Mailing address:
  • Phone: 503-215-9500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD17149
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: