Healthcare Provider Details

I. General information

NPI: 1265987978
Provider Name (Legal Business Name): MITCHELL JON STEELE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2016
Last Update Date: 11/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3101 SW SAM JACKSON PARK RD
PORTLAND OR
97239-3009
US

IV. Provider business mailing address

PO BOX 8500, LOCKBOX 7642 SHRINERS HOSPITALS FOR CHILDREN, PORTLAND
PHILADELPHIA PA
19178-7642
US

V. Phone/Fax

Practice location:
  • Phone: 503-221-3424
  • Fax: 503-221-3490
Mailing address:
  • Phone: 813-281-8115
  • Fax: 813-281-8656

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XP3100X
TaxonomyPediatric Orthopaedic Surgery Physician
License NumberFE177647
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: