Healthcare Provider Details

I. General information

NPI: 1487720710
Provider Name (Legal Business Name): EUGENE M. STOELK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1750 SW HARBOR WAY 200
PORTLAND OR
97201-5128
US

IV. Provider business mailing address

19722 BELLEVUE WAY
WEST LINN OR
97068-2266
US

V. Phone/Fax

Practice location:
  • Phone: 503-227-7799
  • Fax: 503-227-5452
Mailing address:
  • Phone: 503-227-7799
  • Fax: 503-227-5452

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License NumberMD14983
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: