Healthcare Provider Details

I. General information

NPI: 1356548861
Provider Name (Legal Business Name): STEVEN L MANSBERGER MD, MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2007
Last Update Date: 07/14/2025
Certification Date: 07/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1040 NW 22ND AVE SUITE 200
PORTLAND OR
97210-3057
US

IV. Provider business mailing address

1040 NW 22ND AVE SUITE 200
PORTLAND OR
97210-3057
US

V. Phone/Fax

Practice location:
  • Phone: 503-413-8202
  • Fax: 503-413-6937
Mailing address:
  • Phone: 503-413-8202
  • Fax: 503-413-6937

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberMD22167
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code207WX0009X
TaxonomyGlaucoma Specialist (Ophthalmology) Physician
License NumberMD22167
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: