Healthcare Provider Details

I. General information

NPI: 1528363074
Provider Name (Legal Business Name): STEVE GEVURTZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/13/2011
Last Update Date: 01/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

810 NE COUCH ST APT 308
PORTLAND OR
97232-2958
US

IV. Provider business mailing address

810 NE COUCH ST APT 308
PORTLAND OR
97232-2973
US

V. Phone/Fax

Practice location:
  • Phone: 503-307-7264
  • Fax:
Mailing address:
  • Phone: 503-307-7264
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: