Healthcare Provider Details

I. General information

NPI: 1588733489
Provider Name (Legal Business Name): STEPHEN EINAR RENWICK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 02/04/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9427 SW BARNES RD MOTHER JOSEPH PLAZA
PORTLAND OR
97225-6652
US

IV. Provider business mailing address

9427 SW BARNES RD SUITE 200
PORTLAND OR
97225-6652
US

V. Phone/Fax

Practice location:
  • Phone: 503-203-2081
  • Fax:
Mailing address:
  • Phone: 503-203-2036
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XP3100X
TaxonomyPediatric Orthopaedic Surgery Physician
License NumberMD00036102
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code207XP3100X
TaxonomyPediatric Orthopaedic Surgery Physician
License NumberMD21219
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: